Benefits Plans - health plans:
How to Choose a Plan: Evaluating Your Medical Care Needs

The Health Plan Navigator allows you to view side-by-side comparison charts of only the U-M health plans you select to help you decide which plan is right for you. You can select certain plan features that may be particularly important to you, enter your zip code to view plans available in your area, or choose specific plans to compare with your current plan.

Click the link below to access the Health Plan Navigator.

Health Plan Navigator

For more information on individual plans, see Summary of Benefits and Coverage (SBC).

Managed Care Plan:

U-M Premier Care
U-M Premier Care is a Blue Care Network (BCN) health plan offered only to the University of Michigan community. The greatest savings are achieved using the U-M Premier Care Provider Network 1. Members must select a Primary Care Physician (PCP) from U-M Premier Care's Provider Network 1.

Members have access to more limited coverage if they choose to use providers associated with Provider Network 2 (other Michigan BCN providers not included in Network 1). Coverage with these Network 2 providers is subject to an annual deductible of $2,000 per individual and $4,000 per family. A referral from a Network 1 PCP is required for coverage through a Network 2 provider.

Consider the U-M Premier Care plan if you:

  • Would like a health plan that lowers your overall medical costs.
  • Would like a plan that offers the cost savings of an HMO when using U-M Premier Care Provider Network 1, and the option of using other state-wide providers after paying an annual deductible.
  • Agree to choose a physician from a list of approved physicians that includes University of Michigan providers.
  • Agree to consult with your PCP for all services.
  • Understand that to receive coverage for emergency services you must follow plan requirements.
  • Understand that you need a referral from your PCP if you need to see a specialist.
  • Understand that you must live in the state of Michigan.

U-M Premier Care Out-of-Area Dependent Coverage
U-M Premier Care provides coverage for dependents of U-M Premier Care participants who reside outside the network service area and who qualify under existing eligibility guidelines. Pre-certification is required for certain services. The member must register with U-M Premier Care to obtain approval for out-of-area dependent coverage.

Health Maintenance Organization (HMO):

Health Alliance Plan
HMOs usually offer higher benefits and broader coverage than traditional plans at a lower overall out-of-pocket cost. You usually pay no deductible, and benefits are generally paid at 100% after a small co-pay. Plus, you do not have to file claim forms. However, you are limited to the HMO's network of doctors and hospitals.

Consider an HMO if you:

  • Would like a health plan that lowers your overall medical costs.
  • Would like a health plan to have well-baby services as well as preventative services covered.
  • Agree to choose a physician from a list of approved physicians.
  • Agree to use your primary care physician (PCP) for all services.
  • Understand that to receive coverage for emergency services you must follow plan requirements.
  • Understand that you need a referral from your PCP if you need to see a specialist.
  • Understand that you must live in the HMO's service area.

Preferred Provider Organization (PPO):

BCBSM Community Blue PPO
PPOs offer limited out-of-pocket costs, and access to healthcare providers throughout the U.S. Plan members can refer themselves to doctors of their choice, including specialists, inside and outside the network, however higher out-of-pocket costs are incurred for using out-of-network providers.

Consider a PPO if you:

  • Would like a medical plan that allows you to visit any doctor or hospital without a referral.
  • Would like the affordability of a fixed co-pay when receiving services through a national network of providers.
  • Want flexibility to use non-network providers, with higher out-of-pocket costs.
  • Agree to choose from a national network of providers for the greatest out-of-pocket savings.
  • Understand that in-network preventive services are covered but out-of-network preventive services are not covered with BCBSM Community Blue PPO.

Enhancement to Medical Coverage for Services Received Outside the U.S.
Blue Cross Blue Shield of Michigan Community Blue PPO members are covered at the in-network benefit level when receiving care for approved services while outside the U.S., where no network is available. The BCBSM Community Blue PPO is the only plan offering this enhanced level of coverage. To obtain in-network benefits while out of the U.S., check for participating providers at www.bcbsa.com/healthtravel/finder.html.

Traditional Plan:

Comprehensive Major Medical (CMM)
The Comprehensive Major Medical plan, administered by Blue Cross Blue Shield of Michigan, is a traditional major medical plan. 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 use a participating provider. However, for other cvoered services you must meet your annual 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%.

Consider the CMM plan if you:

  • Are looking for a major medical plan that will provide basic coverage for you and your family, but will have increased out-of-pocket amounts to pay.
  • Want a plan that utilizes physicians who are providers with Blue Cross Blue Shield of Michigan (BCBSM) and may cost extra money if you use nonparticipating physicians.
  • Understand that child immunizations would be paid out of your own funds.
  • Understand that coverage is limited to within the United States. Worldwide access to care is available through BlueCard Worldwide┬«, an international network of doctors and hospitals that includes providers in more than 200 countries and territories.
  • Would like a plan with flexible provider choices, but don't mind paying an annual deductible and co-insurance for services.

GradCare for Benefit-Eligible Graduate Students

GradCare is a health plan exclusively for benefit-eligible graduate students. GradCare is administered by Blue Care Network.

Consider GradCare if:

  • You want a health plan with low out-of-pocket costs.
  • You want to use U-M Premier Care Network 1 physicians.
  • You understand that when you are in the GradCare service area you must use your network Primary Care Physician and get a referral if you need to see a specialist.
  • You understand that out-of-network non-emergency services will not be available to you unless you receive special permission from the plan.
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.