Schedule I1 PPO Non Medicare Summary of Benefits.pdf

Non-Medicare Blue Preferred® PPO

Resource Guide Put your coverage to work

Michigan Public School Employees’ Retirement System www.bcbsm.com/mpsers

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SCHEDULE I1 - PPO NON- MEDICARE SUMMARY OF BENEFITS

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Table of Contents

Make the most of your plan ............................................................................................................ Page 2

Keep your health on track with preventive care .............................................................................. Page 3

Know where to go for care .................................................................................................. Page 4

Behavioral and mental health services ............................................................................................ Page 5

LivingWell program ......................................................................................................................... Page 5

Blue Cross® Health & Well-Being ........................................................................................ Page 6

Blue Cross Virtual Well-Being .......................................................................................................... Page 7

Online wellness resources ............................................................................................................... Page 7

Manage your plan anytime, anywhere ............................................................................................ Page 8

Save money and live healthier with Blue365® ............................................................................... Page 10

Get help navigating Social Security Disability Insurance with SSDC ............................................. Page 10

Informational webcasts and webinars ........................................................................................... Page 11

Terms to know ............................................................................................................................... Page 11

Important contact information ...................................................................................................... Page 12

Thank you for choosing Blue Cross Blue Shield of Michigan We want you to know we’re happy you chose our medical plan. Whether you joined for the first time this year or have been with the Blue Cross Blue Shield of Michigan family for years, you might be wondering what you should do to make the most of your coverage this year. Here’s an easy guide to get you up to speed so you can start taking advantage of your plan coverage.

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Make the most of your plan Following these tips will help you maximize your Blue Cross benefits.

■ Remember your Blue Cross membership ID card.

New members: If you haven't already received your new Blue Cross member ID card in the mail, it will arrive soon. Show your primary care provider (PCP) and other healthcare providers this card every time you need care. You can use the Blue Cross mobile app to show your digital member ID card (see page 9).

■ Register for an online Blue Cross member account.

Compare costs, track your healthcare spending, sign up to receive your explanation of benefits (EOB) statements electronically, and take advantage of exclusive member discounts by registering in the secured member section of bcbsm.com/mpsers. You’ll need your Blue Cross member ID card when you sign up.

Register for a Blue Cross member online account by:

• Using the Blue Cross mobile app.

• Visiting bcbsm.com/register.

• Texting REGISTER to 222764.

Message and data rates apply.

Learn more on page 8.

■ Find a doctor.

You have a nationwide preferred provider organization (PPO) medical plan. The Blue Preferred PPO plan offers a network of medical care professionals selected for their quality of care and ability to provide cost-effective services. You pay less out of pocket when you use PPO network providers.

To locate network providers, including patient-centered medical home (PCMH) doctors, use the Find a Doctor tool on the Blue Cross mobile app or at bcbsm.com/mpsers.

■ Consider working with a patient-centered medical home (PCMH).

PCMH doctors follow a team approach to medical care. Your PCMH doctor will lead a team of healthcare professionals dedicated to providing you with the care you need.

Other advantages you’ll experience include:

• 24-hour access to your PCMH care team.

• Coordinated care with your other doctors.

• Personalized strategies for managing your health.

To find a PCMH-designated practice:

1. Visit bcbsm.com/mpsers and click Find a Doctor.

2. Click Get Started. Enter your username and password. If you haven’t registered, click Register for a new account and follow the instructions to create your account.

3. Click the arrow next to Your Plan.

4. Select Employer Group Plans, then choose PPO Plans.

5. Enter your search criteria, then click Search.

6. Filter your search results by checking the PCMH box on the left.

Expect to hear from us Explanation of Benefits

When you receive healthcare services, the healthcare professional or hospital requests payment for the service they provided by submitting a claim. After we process the claim, you get an EOB statement.

You'll receive an EOB the month after the claim is processed. An EOB isn’t a bill. If you owe the healthcare professional or hospital, they’ll send you an invoice.

Best of Health newsletter The Best of Health quarterly newsletter aims to help you understand your medical coverage, improve nutrition and fitness, manage chronic conditions and more. Visit bcbsm.com/mpsers and select For Members and click View All Issues to read the latest issue or sign up to receive your newsletter electronically.

Surveys You may receive surveys asking for your opinion about your retirement system medical plan, our network providers and the care you receive. We’re always looking for ways to provide better coverage and service.

Your answers are confidential. They don’t affect your coverage or costs. We appreciate your honest feedback.

Find it online You can find this resource guide, Your 2024 Benefit Guide, and past issues of the Best of Health newsletter online at bcbsm.com/mpsers.

Keep your health on track with preventive care You may think about seeing your doctor only when something goes wrong, but having regular checkups, the right screenings and a healthy lifestyle can help you prevent or detect life-threatening chronic conditions, such as heart disease and diabetes.

Your Blue Preferred® PPO plan offers preventive services including:

• Breast cancer screening (mammogram).

• COVID-19 (coronavirus) vaccine.

• Flu (influenza) vaccine.

• Hepatitis B vaccine.

• Cervical and vaginal cancer screening (pap test and pelvic exam).

• Pneumonia (pneumococcal) vaccine.

• Prostate cancer screening.

• Routine physical exams and standard, routine lab tests done with the physical.

• Screening colonoscopy.

Keep in mind that the medical and prescription drug plans are administered separately. You’ll need to review the Vaccine Guide to help you understand your retirement system vaccine coverage and out-of-pocket costs. You can find the Vaccine Guide online at bcbsm.com/mpsers, select Medical Plans and click Blue Preferred® PPO.

http://bcbsm.com/mpsers https://www.bcbsm.com/register/online-account/?utm_source=VanityURL&utm_medium=Redirect&utm_campaign=GA_101471&utm_term=Register http://www.bcbsm.com/mpsers http://www.bcbsm.com/mpsers http://www.bcbsm.com/mpsers http://www.bcbsm.com/mpsers http://bcbsm.com/mpsers

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Know where to go for care When it’s not an emergency, you have choices for when and where to get healthcare. Know your options so you can get the treatment you need, right when you need it. Costs vary for each care option, so it’s important to think about what kind best fits your needs:

Primary care provider Call your primary care provider first when you’re not feeling well. He or she knows you best and understands your health history. A patient-centered medical home (PCMH) is a care team led by a primary care provider that focuses on your health goals and needs. They offer 24-hour access to your medical team and a personalized approach to managing your health.

Virtual visits You can receive primary care provider services and behavioral health services online or over the phone directly from your in-network provider if they offer telehealth services.

When your primary care provider is unavailable, connect online with a doctor or therapist by using a smartphone, tablet or computer.

Fast and convenient

Visit bcbsm.com/virtualcare.

Call 1-800-835-2362 with any questions about or to arrange a telephone visit.

Download the Teladoc Health app.

All Virtual Care services from Teladoc Health are separate from virtual care other providers may offer. Remember to follow-up with your primary care provider. Teladoc Health® is an independent company that provides Virtual Care Solutions for Blue Cross Blue Shield of Michigan and Blue Care Network.

24-Hour Nurse Line Talk to a registered nurse at no additional cost anytime when you have questions about an illness or injury. The nurse line can help you determine if you can treat things at home.

Call 1-800-775-BLUE (2583). TTY users should call 711.

Urgent care centers Get non-emergency, in-person care conveniently, after hours or on weekends. You can save money by seeing your primary care provider or going to urgent care for conditions that aren’t life-threatening but need more than home remedies.

Emergency room Seek treatment for serious or life-threatening illnesses or injuries at an emergency room.

Emergency rooms can cost you more because they are equipped to handle trauma and life-threatening situations such as heart attacks, strokes, broken bones and serious injuries.

LivingWell program LivingWell is a program that helps you track your health, identify areas for improvement and work on an action plan with your primary care provider. If you're a new member, you'll have an opportunity to join the LivingWell program in the fall. LivingWell is a program that encourages you to maintain a healthy lifestyle and offers a chance to receive an annual deductible credit for completing the steps below:

1. Choose a primary care provider.

A primary care provider will help you manage your health by keeping track of any conditions you may have and your progress toward health goals. Choosing a primary care provider within the PPO network can reduce your out-of-pocket costs. To locate network providers, use the Find a Doctor tool on the Blue Cross mobile app or at bcbsm.com/mpsers. To get the most out of the LivingWell program, select a PCMH doctor as your primary care provider.

2. Complete the LivingWell questionnaire.

The LivingWell questionnaire asks simple questions on topics such as exercise and nutrition to help give you an idea of your overall health. Complete the questions and include your primary care provider's name in the space provided.

3. Get an annual routine physical.

A routine physical is the best way to catch potential health issues early. Your retirement system medical plan covers a routine physical and standard, routine laboratory tests done in conjunction with your physical once per year at no cost to you in the PPO network. Remember, you may have out-of-pocket costs for non-routine laboratory tests and other services you receive during your routine physical. If you have questions about which tests are covered at 100 percent and which have out-of-pocket costs, call Blue Cross Customer Service at 1-800-422-9146, Monday through Friday 8:30 a.m. to 5 p.m.

Eastern time. TTY users should call 711.

Each year, you'll have a chance to participate in the LivingWell program. You'll receive information about the LivingWell program in the mail from Blue Cross in the fall.

URGENT CARE

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Behavioral and mental health services When times are uncertain, and you're struggling with life challenges and need support, finding the right words can be hard. Everyone can benefit from support. Behavioral health providers can help you even if you’re just experiencing everyday stress.

Meet with a licensed therapist or psychiatrist near you. Most providers offer virtual therapy (one on one or group) and visits by phone.

To locate an in-network behavioral health provider call Behavioral Health Access Line at 1-800-762-2382 (TTY:711) or use the Find a Doctor tool on the Blue Cross mobile app or at bcbsm.com/mpsers.

To learn more about the behavioral and mental health resources available to you, visit bcbsm.com/mentalhealth.

http://bcbsm.com/virtualcare http://www.bcbsm.com/mpsers http://bcbsm.com/mpsers http://bcbsm.com/mentalhealth

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Blue Cross Health & Well-Being Whether you're looking for ways to improve your lifestyle or manage a chronic illness such as asthma or high blood pressure, Blue Cross Health & Well-Being has the support system you need.

Blue Cross Coordinated Care Advocate The Blue Cross Coordinated Care Advocate program allows you to get help, answers and clarity with just about anything related to your healthcare.

A member advocate is a registered nurse ready to help you. Whether you want advice about an upcoming surgery, are seeking information on a specific condition or need guidance in selecting a doctor, member advocates:

• Make the healthcare process easier.

• Guide and support you in making decisions.

• Give you advice to get the best care available for your specific needs.

• Can assist with scheduling healthcare appointments.

Member advocates are like having a nurse in the family to turn to with your medical concerns. They’ll take the right steps to make better whole body healthcare happen for you.

To contact a member advocate, call 1-800-422-9146 Monday through Friday from 8:30 a.m. to 5 p.m.

Eastern time.

Once you’ve connected with a member advocate, you can stay in touch using the Blue Cross Coordinated CareSM app. To get started with the app, visit bcbsm.com/coordinatedcare on a smart phone or tablet, or search BCBSM Coordinated Care in Google Play™ or the App Store®. Your access code is ADV.

Quit tobacco for good The Tobacco Coaching program, powered by WebMD®, provides members with the support and resources needed to establish and embrace a tobacco-free life. The 12-week program includes over-the-phone coaching for quitting all types of nicotine products, including electronic cigarettes and vaping devices. And it’s offered at no extra cost to you.

When you start the program, you’ll receive:

• Five calls from a specially trained health coach over a 12-week period.

• Unlimited calls to a health coach.

• Online resources.

About seven months after the program ends, your health coach will contact you to check on your progress.

Health coaches are available seven days a week, so you can schedule calls at a time that’s convenient for you.

Call 1-855-326-5102, TTY users call 711, to schedule your first Tobacco Coaching session. All hours are Eastern time: Monday through Thursday 9 a.m. to 11:30 p.m.; Friday 9 a.m. to 8 p.m.; Saturday 9:30 a.m.

to 6 p.m.; Sunday 1 to 11:30 p.m.

Blue Cross Virtual Well-Being Let Blue Cross Virtual Well-Being give you the guidance and support you need on your personal well-being journey.

Highlights:

• Features short, high-energy, live webinars every Thursday at noon Eastern time. Additionally, meditation sessions go live every Wednesday at 7:30 a.m. Eastern time.

• Focuses on a different well-being topic each week.

• Topics include mindfulness, resilience, social connectedness, emotional health, financial wellness, gratitude, meditation and physical health.

• Offers informational materials you can download to save and share.

Conveniently watch Blue Cross Virtual Well-Being webinars on your computer, tablet or mobile phone.

Learn more, register or watch past webinars at bluecrossvirtualwellbeing.com.

Online wellness resources Blue Cross Health & Well-Being online resources, powered by WebMD®, gives you access to a broad range of free online health and well-being programs. Best of all, they’re available at your fingertips 24 hours a day, every day. Just log in to your member account on the Blue Cross mobile app or at bcbsm.com/mpsers and then click Health & Well-Being to get started.

Audio Library — Listen to audio presentations for a variety of topics about preventing and managing illnesses.

Health Assessment — Complete your health assessment to find out your personal health risks and what you can do to improve your health.

Health record — Store, maintain, track and manage your health information in one central, private and secure location.

Health trackers — Chart your measurements over time. There are trackers for exercise, steps, diet, sleep, mood, pain and tobacco use.

Message board exchanges — Connect with others who have the same interests and health concerns as you. Ask questions and find credible answers from experts in these professionally monitored message boards.

My Health Assistant — There are six Digital Health Assistant programs available at no additional cost to you that focus on a variety of health goals, including eating better, conquering stress, feeling happier, enjoying exercise and more. All tips come straight from WebMD’s expert health coaches.

Recipes — Find more than 400 tasty and healthy recipes that can help you meet your nutritional needs.

Symptom checker — Use this interactive tool to help you determine what to do about your symptoms.

The Daily VictorySM and Weigh Today apps — Download these WebMD apps to your mobile device and then easily sync them with the Blue Cross Health & Well-Being site to start making small changes in your exercise habits and weight.

WebMD

HealthTopicsSM — This valuable resource allows you to search for a variety of health topics organized by conditions, general health, procedures and surgeries.

Interactives — Find calculators, guides, quizzes, slide shows and other health information you may need.

Videos — Watch more than 1,000 videos about a variety of health topics and trends.

WebMD is an independent company that provides health and well-being information for Blue Cross Blue Shield of Michigan members.

http://bcbsm.com/coordinatedcare http://bluecrossvirtualwellbeing.com

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Manage your plan anytime, anywhere Online member account An online account at bcbsm.com/mpsers lets you choose what’s best for you. Everything you need to manage your medical plan – and your health – is all in one secure place. Register for an account at bcbsm.com/mpsers and log in to:

■ Check your balances See a snapshot of your plan pulled together in one clear view. Easy-to-understand, time-saving charts show your deductible and coinsurance maximum.

■ Monitor your claims activity View recent claims activities, including how much your plan covers and how much you’ll owe. You can check claims activity as far back as two years or narrow your search results to find exactly what you’re looking for.

■ Go paperless Each month that you receive services, you'll receive an EOB statement that shows which services your retirement system medical plan paid for, any services they did not pay for and why, as well as any charges you may owe. To help you stay organized and avoid the clutter, you can sign up to receive emails when a new EOB statement is posted in your online member account. By signing up to receive electronic EOBs, you’ll stop receiving paper EOBs in the mail and start getting them faster.

Going paperless is easy. Here’s how:

1. Go to bcbsm.com/mpsers. Click Log in. Enter your username and password. If you haven’t registered, click Register Now and follow the instructions to create your account.

2. Click Account Settings at the top.

3. Click Paperless Options on the left.

4. Under Choose Delivery Method, click Change to select paperless delivery of the documents you want to get online. To the right, confirm the email address displayed is where you want to receive notifications.

■ MIBlue Virtual Assistant MIBlue Virtual Assistant is an interactive, automated chat feature available through your online Blue Cross member account. You can also use our app and select the Virtual Assistant icon.

Use the virtual assistant to:

• Check your coverage. • Find options for care.

• Find a certain claim. • Look up your deductible and other balances.

• Order another member ID card • Search for healthcare professionals and update your paperless options. and hospitals.

Access your plan on the go with the Blue Cross mobile app The Blue Cross mobile app provides the tools and features to help you access information and make informed decisions from the convenience of your smartphone. From seeing where you stand with your deductible and coinsurance maximum, to reviewing claims, to finding the best healthcare professional or place to go for treatment – count on our mobile app to give you the information you need – when and where you need it.

These are just some of the app's features:

Benefit details See what your plan covers so you’re informed when you need care.

Cost share Know how much you’ve paid toward your deductible and your coinsurance maximum.

Cost calculator Compare cost estimates for healthcare services.

View claims and EOBs See what your providers charged and why, before you pay. Quickly filter and search claims by time frame, member, service type or provider.

Find a Doctor Find a doctor or hospital in the PPO network.* Search by location, PCMH doctors, specialties, quality recognitions and extended office hours. You can even get GPS-enabled directions to help you get there fast.

Virtual member ID card Show your virtual member ID card to your doctor so they have the information they need to look up your coverage.

MIBlue Virtual Assistant Quickly find answers to questions about your plan 24/7 using this interactive, automated chat feature.

Search “BCBSM” in the Apple® App store or Google® Play and download it today.**

*Always call providers before visits to confirm they're in network.

** All members with an Android OS 4.5 or higher and iPhone iOs 7.1.2 or higher smartphone. App Store® is a service mark of Apple Inc., registered in the U.S. and other countries.

Google Play is a trademark of Google LLC.

No internet?

No problem.

If you don’t use the internet, don't worry. You can get the information you need by calling Blue Cross Customer Service at 1-800-422- 9146 from 8:30 a.m. to 5 p.m.

Eastern time, Monday through Friday. TTY users should call 711.

Sleeping Bear Dunes National Lakeshore. Empire, Michigan http://www.bcbsm.com/mpsers

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Save money and live healthier with Blue365®

Blue Cross Blue Shield of Michigan members can score big savings on a variety of healthy products and services from businesses in Michigan and across the United States.

We’ve got plenty of deals to keep you and your family healthy.

Member discounts with Blue365 offers exclusive deals on things like:

• Fitness and well-being: gym memberships, fitness gear, fitness wearable devices and health magazines.

• Nutrition: meal delivery kits and weight-loss programs.

• Lifestyle: landscaping materials, pet supplies and multivitamins.

• Travel: hotel reservations, car rentals and vacation activities.

Join Blue365 and start saving today!

To view a full list of discount offers, log in or register at bcbsm.com/mpsers and click Blue365 member discounts. If it's your first time visiting Blue365, have your member ID card handy. In just a few minutes, you'll be registered and ready to shop.

Sign up to get monthly updates and details about new offers delivered directly to your email inbox.

Get help navigating Social Security Disability Insurance with SSDC Blue Cross knows Social Security Disability Insurance (SSDI) is complex and a confusing process for so many people. That’s why the team at SSDC Services Corporation (SSDC) is ready to help. SSDC can assist you in finding out whether you or your spouse may qualify for SSDI benefits, and if so, assist with applying for benefits. Using SSDC services at the very beginning can help you receive your SSDI benefits in less time, increase your monthly income, provide additional healthcare insurance for you and your dependents, and may increase your Social Security retirement benefits later.

SSDC reaches out to members who may qualify for SSDI benefits. With SSDC, you don't have to go through the process alone. If you would like to learn more about SSDC or find out if you or your dependent may qualify for disability insurance, contact SSDC at ssdcservices.com* or call 1-877-768-3018, ext. 222 from 9 a.m. to 6 p.m. Eastern time, Monday through Friday. TTY users should call 711.

*Blue Cross Blue Shield of Michigan doesn't own or control this website.

Terms to know Coinsurance The percentage you pay for the cost of covered medical services. The amount of your coinsurance is based on the Blue Cross approved amount. You pay 10 percent coinsurance for most covered services and your retirement system pays the remaining 90 percent.

Coinsurance maximum The maximum amount you'll pay in coinsurance, per member, during the calendar year when using in-network providers. You start paying 10 percent coinsurance for most covered services at the beginning of the year when you use in-network providers. Once you reach the coinsurance maximum, most covered services that were paid at 90 percent will be paid at 100 percent of the Blue Cross approved amount for the remainder of the calendar year and the 30 percent coinsurance for out-of-network services will be reduced to 20 percent. You have an annual coinsurance maximum of $900 per member during a calendar year.

Copay or copayment A flat dollar amount that you pay when you receive certain medical care services. Copays are not included in the annual coinsurance maximum. Once the annual coinsurance maximum is met, you pay a $65 copay for urgent care visits and a $135 copay for emergency room care.

Deductible A fixed dollar amount you must pay during each calendar year before covered services and supplies are paid by your retirement system. The deductible is applied after the coinsurance. You have an annual deductible of $1,000. For members enrolled in the LivingWell program, the annual deductible is $850 or $800 based on the number of program steps completed. If you’re a new member, you’ll have an opportunity to participate in the LivingWell program and will receive information from Blue Cross in the fall.

Informational webcasts and webinars Check out the webinar library at bcbsm.com/mpsers to view educational videos on topics to help you understand your retirement system medical plan. Topics include Boosting your healthcare knowledge and the Online Retiree Healthcare Plan Seminar. You can also find information about managing chronic conditions and the Blue Cross Patient-Centered Medical Home Program.

To access the webinars:

• Visit bcbsm.com/mpsers.

• Click For Members at the top of the page.

• Click View Webinars.

St. James on Beaver Island in Northern, Michigan, USA http://www.bcbsm.com/mpsers http://www.ssdcservices.com

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Important contact information Michigan Office of Retirement Services For address changes, information about your pension account and membership enrollment updates, contact the Michigan Office of Retirement Services.

michigan.gov/orsschools michigan.gov/orsmiaccount - for miAccount

1-800-381-5111 Monday through Friday, 8:30 a.m. to 5 p.m., Eastern time TTY users should call 711.

Michigan Office of Retirement Services PO Box 30171 Lansing, MI 48909-7671

Note: Your prescription, dental and vision plans are provided by vendors that partner with your retirement system.

These plans do not provide Blue Cross branded products and services.

By phone Call Blue Cross Customer Service at 1-800-422-9146, Monday through Friday 8:30 a.m. to 5 p.m.

Eastern time. TTY users should call 711.

By mail Write to:

MPSERS Customer Service Center Blue Cross Blue Shield of Michigan 232 S. Capitol Ave.

Lansing, MI 48933-1504

In your letter, include your name, address, day and evening telephone numbers and your enrollee ID as shown on your Blue Cross member ID card.

Online or Blue Cross mobile app Manage your plan and find answers to your coverage questions on our website or mobile app. Log in to your member account at bcbsm.com/mpsers to:

• Get cost estimates for healthcare services.

• Check the status of a claim.

• View your annual documents and go paperless.

• View your EOB statements electronically.

• Order new member ID cards.

If you need assistance or have questions about the mobile app visit bcbsm.com/app or call 1-888-417-3479 (TTY: 711) 8 a.m. to 8 p.m. Eastern time, Monday through Friday.

TruHearingTM

Routine hearing care: 1-855-205-6305.

TTY users should call 711.

8 a.m. to 8 p.m.

Monday through Friday truhearing.com/mpsers*

Note: Your routine hearing care benefit is brought to you through an arrangement between Blue Cross and TruHearing. TruHearing is an independent company that provides hearing care services.

*Blue Cross Blue Shield of Michigan doesn't own or control this website.

Important Blue Cross contact information Do you have questions or want more information? Keep this important contact information at your fingertips.

Blue Cross Customer Service

Arch Rock on Mackinac Island Michigan http://michigan.gov/orsschools http://michigan.gov/orsmiaccount http://www.bcbsm.com/mpsers http://bcbsm.com/app http://truhearing.com/mpsers

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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

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