Blue Care Network of Michigan
Blue Cross® Preferred HMO Bronze Saver HSA
Plan Overview
Combined Medical and Drug Deductible |
|
Combined Medical and Drug Out of Pocket Maximum |
|
Office Visit
Primary Doctor |
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Specialist |
|
Prescription Drug Information
Preferred Brand Drugs |
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Non Preferred Brand Drugs |
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Generic Drugs |
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Specialty Drugs |
|
Inpatient Coverage
Hospital Services |
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Inpatient Services |
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Emergency and Urgent Care
Emergency Room |
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Urgent Care Facility |
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Maternity
Labor and Delivery Hospital Stay |
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Pre and Postnatal Office Visit |
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Vision
Routine Eye Exams For Children |
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Major Dental Care
Routine Dental Checkups for Children |
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Routine Dental Checkups for Adults |
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Basic Dental Care - Adult |
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Basic Dental Care - Child |
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Major Dental Care - Adult |
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Major Dental Care - Child |
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The premiums shown include BCBSM's/BCN's estimates of applicable Federal and state taxes, fees and assessments. BCBSM's/BCN's estimates are subject to change. BCBSM/BCN will not reconcile or settle any amounts collected with actual amounts owed for such Federal and state taxes, fees, and assessments.
HSA Eligible Products
Products that are HSA eligible:
Blue Cross® Premier PPO Bronze HSA
Blue Cross® Premier PPO Silver Saver HSA
Blue Cross® Preferred HMO Bronze Saver HSA
Blue Cross® Select HMO Bronze Saver HSA
Blue Cross® Metro Detroit HMO Bronze Saver HSA
There is a $0* charge per month for our HSA. If you would like to learn more please visit: www.bcbsm.com/healthybluehsa.
* fee is subject to change
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