Blue Cross Blue Shield PPO and M-CARE PPO PLUS Offer Comparable Portability at Lower Cost

Click here to see the article that ran in The University Record on May 8, 2006.

When will U-M’s Blue Cross Blue Shield/United traditional plans be eliminated?
These plans will end at midnight on December 31, 2006. If you are currently enrolled in this plan, you can choose a new medical plan during Open Enrollment in October, and your new plan choice will become effective on January 1, 2007.

Do claims need to be filed before the plan is eliminated?
No. Coverage under the BCBS/United traditional plan continues through December 31, 2006, but members can file claims through the end of 2007 for expenses incurred in 2006.

Why is the BCBS traditional plan being eliminated?
The University re-examines our mix of vendors and plan types each year to determine what changes, if any, are needed to continue to offer a choice of high-quality plans. Since the introduction of our PPO plans (M-CARE and BCBS) in 2005, 41% of those in the BCBS traditional plan have already opted for an alternate U-M plan.  Declining enrollment in the traditional plan, the ability to provide nationwide coverage (and international coverage with BCBS PPO) with the new M-CARE and BCBS PPO plans, and the lower monthly premiums for both U-M and the plan members who opt for PPO or HMO plans were key factors in making the decision to eliminate the BCBS/United traditional plans beginning in 2007.

Do I need to take any immediate action to make sure I have uninterrupted medical insurance?
No. The BCBS traditional plan will continue in force until the end of 2006. If you are currently enrolled in the BCBS/United plan, you should review all of the other U-M medical plans during the next Open Enrollment period (October 2006) to determine which plan best meets your needs. You can select a new plan at that time, and coverage under the new plan of your choice will begin on January 1, 2007. There will be no interruption in your medical insurance coverage.  In fact, if you do not actively choose a new plan during Open Enrollment, the Benefits Office will automatically enroll you in the Blue Cross Blue Shield PPO plan by default, which will ensure continuous coverage for you and your covered dependents.

What other U-M plans are comparable?
U-M will continue to offer seven other health plans to faculty and staff, plus GradCare for graduate students, so it is important that you choose whichever plan best meets the needs of you and your covered dependents during Open Enrollment.  One of the key features of the traditional BCBS plan has been the portability of the plan – there is no geographical service area typical of HMO plans. The BCBS Comprehensive Major Medical (CMM) plan offers similar flexibility in choosing providers but has higher out-of-pocket costs. The Blue Cross Blue Shield PPO and the M-CARE PPO PLUS plans offer the portability of nationwide physician networks at co-premiums that, in most cases, are substantially lower than the co-premiums for the BCBS traditional plan.

Do all physicians who accept the BCBS/United plan also accept the BCBS PPO?
Not necessarily.  Blue Cross Blue Shield reports that greater than 90% of physicians nationwide accept both BCBS traditional and the BCBS PPO, including specialists. You should verify that your physician is part of the provider network of any plan you are considering if it is important to you to continue with the same doctor. Contact the plan directly.

What are some of the advantages of a Preferred Provider Organization (PPO) plan?
PPO plans are generally portable, meaning you can visit a physician in the network at covered, in-network rates. Both of the PPO plans offered at U-M include nationwide networks of care providers so these plans may be well worth considering if you live outside the local area either all or part of the year.  Also, none of the HMO, PPO nor POS plans require the filing of paper claims forms for reimbursement when you visit network providers.

What information and tools will be available to help me select a new plan?
You will receive information on all of the plan options prior to Open Enrollment during October. This information will include a plan comparison chart so you can review the key features of each plan, as well as a cost comparison chart to show you the monthly co-premiums for each plan you can choose.  Also, you will find links in the material to the Benefit Office’s Medical Plan Navigator, an online tool to select key plan features (e.g., vision coverage or nationwide provider network) and view only those plans that meet your criteria side by side on your computer screen. You can also contact the HR/Payroll Service Center or meet with a Benefits Office specialist if you have specific questions about your eligibility for plans. Prior to choosing a PPO, we encourage you to call the plan (BCBS or M-CARE), or check their website to be sure your physician or hospital of choice is included in their network.

If I stay with BCBS and enroll in the PPO, will I pay more than I do now?
No. Based on 2006 rates, the BCBS PPO plan currently offers coverage at lower cost (at every coverage level) than the BCBS/United traditional plan. For office visits, BCBS traditional members must pay an annual deductible ($250 for individuals and $500 for families) and then pay 20% of the charges after the deductible is met.  PPO members pay only $15 or $20 for office visits when using the plan’s network of providers.

How will my out-of-pocket expenses change for prescription drugs?
You should have lower out-of-pocket expenses for prescription drugs in any U-M plan as compared to the BCBS traditional plan.  For example, BCBS traditional plan members pay the full price of their prescription drugs until the annual deductible is met ($150 for individuals; $300 for families) and 20% of each prescription thereafter. But all other U-M plans utilize our 3-tier copay system with no deductible (current copays are $7 per generic drug; $14 for brand-name drugs; $24 for non-preferred brand-name drugs). (Note: Active employees covered by a collective bargaining agreement should check their current agreement for the drug copay rates in effect. Collective bargaining agreements to not apply to retirees.)

Can I get care outside of the U.S.?
Yes. The BCBS PPO treats services received outside the U.S. as in-network claims, reducing member costs for travelers and out-of-country residents. All U-M plans cover emergency medical care anywhere in the world if a serious accident or illness requires treatment while you are away.

I am retired and enrolled in Medicare. Do all physicians who accept Medicare also accept the BCBS PPO?
Yes. All physicians who accept Medicare nationwide will accept the BCBS PPO at in-network coverage levels for members with Medicare as their primary insurer; therefore most providers and hospitals in the U.S. will be considered in-network for Medicare-enrolled retirees and their dependents.