Community Blue PPO Plans For PML Employees
The Community Blue PPO is a comprehensive medical package with relatively low out-of-pocket
expenses.
With a PPO plan, you have complete freedom to see any doctor of your choice. If you choose
doctors and hospitals within the BCBSM PPO network, your out-of-pocket costs are lower than if
you use other providers. BCBSM has the largest network of providers in Michigan with over
13,000 primary and specialty care physicians and more than 150 hospitals.
NOTE: If you are traveling or reside outside of Michigan, you can also access BCBSM PPO
providers in other states. PPO providers submit claims to their local BCBSM plan for payment.
To locate PPO network providers:
1. Ask your doctor whether he/she is a BCBSM PPO provider.
2. Call BCBSM at: 1-800-810-BLUE; or
3. Visit the BCBSM web site on the Internet at: www.bcbsm.com for PPO providers in
Michigan or www.bluecares.com for PPO providers in other states.
These are some of the highlights of the plan when you
use a participating provider in the PPO network:Community Blue PPO Plan 2The PPO plan provides coverage at 90% for most in-network services after a $100 single/$200
family deductible. Out-of-network services are covered at 70% after a $250 single/$500 family
deductible.
* $15 office visit Co-pay (medically necessary office visits)
* $15 office visit Co-pay for chiropractic care
* $15 Urgent Care Facility Co-pay
* $50 Emergency Room Co-pay
* 100% coverage up to a $250 annual maximum per member for your preventive care benefits including:
- Routine physical exams
- Gynecological exams
- Well baby/child care to age 15
- Immunizations to age 16
- Routine Pap Smear (one per calendar year)
- Prostate-Specific Antigen (PSA) (one per calendar year)
Community Blue PPO Plan 4
The PPO plan provides coverage at 80% for most in-network services after a $500 single/$1,000
family deductible. Out-of-network services are covered at 60% after a $1,000 single/$2,000
family deductible.
* $15 office visit Co-pay (medically necessary office visits)
* $15 office visit Co-pay for chiropractic care
* $15 Urgent Care Facility Co-pay
* $50 Emergency Room Co-pay
* 100% coverage up to a $250 annual maximum per member for your preventive care benefits including:
- Routine physical exams
- Gynecological exams
- Well baby/child care to age 15
- Immunizations to age 16
- Routine Pap Smear (one per calendar year)
- Prostate-Specific Antigen (PSA) (one per calendar year)
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