Benefits Plans - health plans: Plan Summary -
Comprehensive Major Medical (CMM)

The Comprehensive Major Medical option is a traditional major medical plan and is administered by Blue Cross Blue Shield of Michigan.

You are free to use the provider of your choice, including specialists, however your out-of-pocket costs are lower if you use a participating Blue Cross Blue Shield provider. Benefits paid to nonparticipating providers are limited to a Blue Cross fee schedule, and nonparticipating providers may charge more than the fee schedule allows. You pay 100% of any charges in excess of the fee schedule.

Many preventive services are paid at 100% when you us a participating provider, however for other services you must meet your deductible of $500 per individual or $1,000 per family before benefits are paid no matter which provider you use. Once you satisfy your deductible, the plan will pay 80% of most eligible services, while you pay the remaining 20%. Once you have paid $3,000 individual or $6,000 for your family out of your own pocket, including the deductible, the plan will pay 100% of approved covered services. The out-of-pocket maximum does not include non-covered charges, expenses paid at a 50% co-insurance, and costs that exceed the plan's fee allowance for a particular service. Prescription drug co-pay amounts do not apply to the CMM out-of-pocket maximum.

Coordination of Benefits

When you first enroll, you will need to complete a BCBSM Coordination of Benefits (COB) form before any claims are paid. All your claims will be denied until the form is received by BCBSM. At that time, you will have to refile all rejected claims. COB Forms will be sent to you in January, but they are also available for download from the Health Plan Forms page and from the Blue Cross Blue Shield website at http://www.bcbsm.com/forms/members/pdf/cob.pdf (PDF).

International Claim Filing

View the BlueCard Worldwide® section for information on filing a claim when you need medical care outside the U.S.

For more information see Summary of Benefits and Coverage (SBC)

 

Limitations
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.