Medical and Prescription Drug Plans

DFA is committed to offering comprehensive health insurance to our employees in 2023 through the Blue Cross Blue Shield Blue Care Network of Michigan. Services must be provided or arranged by the member’s primary care physician or health plan.

Benefit

Annual Deductible Employee Only Family

(Employee + Spouse, Employee + Children or Family)

Allergy Injections Office Visits Referral Physician Visits Urgent Care Facility Emergency Room Visit Ambulance Preventive Care Coinsurance Diagnostic Tests and X-rays: High Technology Radiology Imaging (MRI, MRA, CAT, PET) $500 $1,000

$0 $20 $30 $35 $250 (copay waived if admitted) $25 100% 50% 100% after deductible

$150 copay after deductible

Out-of-Pocket Maximum

(Applies to deductibles, copays and coinsurance amounts for all covered services. Includes pharmacy cost-sharing.) Employee Only Family $8,150 $16,300

(Employee + Spouse, Employee + Children or Family)

Prescription Drugs: Retail Pharmacy (30-Day Supply)

Prescription Drugs: Mail Order (90-Day Supply)

Tier 1 (Generic): $10 copay Tier 2 (Preferred): $40 copay Tier 3 (Non-preferred): $80 copay Tier 1 (Generic): $20 copay Tier 2 (Preferred): $80 copay Tier 3 (Non-preferred): $160 copay

FOR QUESTIONS, CONTACT BCN TODAY!

BCN Customer Service

1-800-662-6667 (TTY users: 711)

Or call the number on the back of your ID card.

8 a.m. to 5:30 p.m. Monday through Friday

Find BCN online:

• www.bcbsm.com • news.bcbsm.com • www.facebook.com/MiBCN • www.ahealthiermichigan.org • www.twitter.com/bcbsm • www.youtube.com/bcbsmnews

COVERAGE THAT TRAVELS

As a Blue Care Network member with BlueCard coverage, you can receive benefits when you’re away from home. So can your dependents. Just show your member ID card.

Physicians and hospitals that contract with Blue plans nationwide participate in BlueCard.

You can locate BlueCard providers at www.bcbsm.com. Select Find a doctor from the home page. In search options, select Traveling? Find out how to get care. You can also call BlueCard at 1-800-810-2583.

PHARMACY COVERAGE

Your BCN ID card is accepted at thousandsof pharmacies nationwide, including most major chains, that participate with Blue plans.

BLUE CROSS MEMBER ONLINE ACCOUNT

HOW TO REGISTER

Online:

Go to www.bcbsm.com/register and select Register Now. Once your account is activated, you can set up one for each of your dependents.

Text

Text REGISTER to 222764.

Use the app

• Download the app by searching BCBSM on the App store or on Google Play. • Tap the app icon and then Register. • Use the app to snap a photo of your ID card. Your enrollee ID number will be entered for you.

Using an online account allows you to easily: • Check your balances and coverage. • Monitor claims and explanation of benefits statements. • Search for doctors, hospitals and specialists. • Compare costs for health care services. • Find peace of mind with quality hospital care. • Carry your ID card safely. • Stay healthy, store your health records and track your goals in one location. • See the status of authorizations and referrals. • Use your member discounts.