Comprehensive Major Medical
Community Blue PPO •   Plan #2 Benefit Chart •   Plan #3 Benefit Chart •   Plan #4 Benefit Chart •   Plan #11 Benefit Chart •   Optional Prescription Drug Coverage •   Eligibility Requirements •   How To Apply For Coverage •   Premium Rates •   Preexisting Condition Waiting Period
Download the Brochure in PDF format
Blue Care Network HMO

Community Blue PPO

---

Our Community Blue PPO plan is a comprehensive plan offering preventative and wellness benefits when you use participating PPO physicians in addition to comprehensive inpatient and outpatient care, laboratory tests and x-rays. Plus, when you use Blue Preferred PPO physicians, your office visits will require only a $10 office visit copayment.

Our Community Blue PPO plan is available in four deductible options: $100, $250, $500 and $1,000. You only need to meet two deductibles per family. Once your deductible is met, BCBSM pays either 80% or 90% of your covered benefits for general services and you pay the remaining 20% or 10% (depending on the deductible option you choose). There is also a copayment maximum on this plan that varies depending on the deductible option you choose. Once you have met your copayment maximum, BCBSM will pay 100% of your covered benefits for general services for the remainder of that calendar year.

Blue Preferred PPO network

When you belong to our HSA CMM-PPO plan, you'll have an entire network of more than 16,000 Blue Preferred Provider Organization (PPO) physicians and more than 140 hospitals in Michigan available to you to get the best benefits at the best price. The network also extends nationwide for those who travel out of state. Most services are also covered if you choose to use a provider who is not in the PPO network, however, you will be responsible for higher copayments, and some services may not be covered.

In-network deductible options

Plan 2 - $100 per person; $200 per family.
Plan 3 - $250 per person; $500 per family.
Plan 4 - $500 per person; $1,000 per family.
Plan 11 - $1,000 per person; $2,000 per family.

Copayments (percent)

Plan 2 - 10% in-network for general services not performed in a PPO physician's office; 30% out-of-network.
Plan 3 - 20% in-network for general services not performed in a PPO physician's office; 40% out-of-network.
Plan 4 - 20% in-network for general services not performed in a PPO physician's office; 40% out-of-network.
Plan 11 - 20% in-network for general services not performed in a PPO physician's office; 40% out-of-network.

Copayment dollar maximums (annual)

Plan 2 - $500 per member/$1,000 per family in-network. $1,500 per member/$3,000 per family out-of-network.
Plan 3 - $1,000 per member/$2,000 per family in-network. $3,000 per member/$6,000 per family out-of-network.
Plan 4 - $1,500 per member/$3,000 per family in-network. $3,000 per member/$6,000 per family out-of-network.
Plan 11 - $1,000 per member/$2,000 per family in-network. $2,000 per member/$4,000 per family out-of-network.