Medical Coverage

NMU’s PPO Plan1 through Blue Cross Blue Shield of Michigan (BCBSM) uses a network of physicians, hospitals, and other health care specialists who have signed agreements with us to accept the approved amount as payment in full for covered services.  When you use PPO network providers, your out-of-pocket costs for covered services are limited to the co-pays and deductibles stated in the summary of benefits. Here’s what you need to do when you need medical care:

• Choose a provider from the BCBS Provider Directory.

• Make your appointment directly with that provider.  You can also ask your provider if they are in the PPO Network.

You do not have to choose just one provider for your care and you do not have to notify us if you decide to change physicians.  Just remember to select your provider from the directory and you will stay in-network.  If you would like to verify if a provider is in the BCBS network, please review the Provider Directory or contact BCBS's customer service line at 800-879-1945.

To receive benefits at the in-network level, your care must be received from a Community Blue PPO provider.  You do not need to use Community Blue PPO network provider for the following services, you must however, follow coverage requirements.

• Services where there is no network available.

• Services covered under a separate dental, or vision plan.

Special Note for Parents of Students:  If you have dependents attending school, but living away from home, you should help them choose a Community Blue Preferred PPO physician near their school.  Please refer to the nation-wide provider directory.


Non-Network Providers

When you receive care from a provider who is not part of the Community Blue PPO network, without a referral from a PPO provider, your care is considered out-of-network.

Before choosing a non-network provider, you should verify if the service would be covered.  Some services, such as your preventative care services, are not covered out-of-network.

If you choose to receive services from a non-network provider, you can still limit your out-of-pocket costs if the provider participated in traditional BCBS plans.

If you use BCBS participating providers outside the PPO network:

• The provider will bill BCBS directly for your services.

• You will not be billed for any differences between BCBS’s approved amount and the provider charges.

 

How do I appeal a health plan decision?