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Retiree Health Care FAQs

The following reflect some of the more commonly asked questions regarding MSU Retiree Health Care Programs by category. We hope this quick reference is helpful. To get answers to other questions, please contact MSU Human Resources at (517) 353-4434, toll-free at (800) 353-4434 ext. 0 or via email at benefitsinfo@hr.msu.edu.

Blue Care Network (BCN) Frequently Asked Questions

Deductibles

  Retiree Contributions

Coverage Options

Access to MSU Health Plan Coverage for Spouse or Other Eligible Individual

CVS Caremark Prescription Drug Plan

Health Care Reform (also known as the "Patient Protection and Affordable Care Act") 


Blue Care Network (BCN) Frequently Asked Questions 

Do I need a primary care physician?
Yes. Having a primary care physician means you’re more likely to get preventive health care on time. Your doctor becomes familiar with your family and medical history and becomes a more effective health partner. You also pay the least when your primary care physician provides or coordinates your care.

Do I get to choose my own doctor?
Yes. You can choose a primary care physician who is an M.D. (medical doctor) or a D.O. (osteopathic doctor). Each person covered under your contract should select a primary care physician, but members of the same family don’t have to have the same physician. Adults may choose one doctor type for themselves and another for their children from these categories:

  • Family medicine and general practice — These practitioners treat patients of all ages, from newborns to adults. They also provide obstetrical and gynecological care. Women can also seek care from an OB-GYN in addition to a primary care physician (see below).
  • Preventive medicine — These practitioners promote health and well-being for patients of all ages.
  • Internal medicine — Internists are trained to identify and treat adult and geriatric medical conditions. Most of our network internists treat patients age 18 and older.
  • Internal medicine/pediatrics — Physicians who are trained in internal medicine and pediatrics treat infants, children, adolescents and adults.
  • Pediatrics — Pediatricians specialize in the treatment of infants, children and adolescents 18 years and younger.

How do I choose a primary care physician?
Log on to the BCN website any time day or night and open the physician selection tool (http://www.bcbsm.com/index/common/find-a-doctor.html) to search for and select physicians. You can also call BCN Customer Service at 1-800-662-6667 from 8 a.m. to 5:30 p.m. Monday through Friday. TTY users can call 1-800-257-9980.

What about special care for women?
BCN’s Woman’s Choice program allows you to visit a BCN-affiliated gynecologist, obstetrician or OB-GYN without coordinating the service with your primary care physician. This includes routine care like Pap smears, annual well-woman visits and obstetrical care.

Tip: Consider selecting an OB-GYN who belongs to the same physician group as your primary care physician or has privileges at the same hospital. This makes it easier for them to take care of you as a team.

I live outside of the Lansing area. Does my doctor have to be in a certain area?
No. Your doctor can be located anywhere in our service area. See the service area map.

Can I receive services from a non-contracted provider?
You may choose to receive benefits in- or out-of-network whenever you need them. However, you’re only eligible for in-network benefits when you receive covered health services from a BCN participating provider. We suggest you coordinate your health care needs with your primary care physician. This will ensure that you pay the lowest deductible, coinsurance and copayments. Certain covered out-of-network health services from a provider who doesn’t participate with BCN must be authorized by BCN before you receive them. Services not authorized by BCN aren’t payable.

Who is responsible for notifying BCN when I seek services out of network if a service requires a prior authorization?
You must have BCN authorization for certain services before you get care from providers who aren't part of our network. You are responsible for getting this authorization by calling 1-800-392-2512. However, providers can contact BCN on your behalf. If you receive medical care from providers who aren't part of our network without BCN authorization as required for specific services, you'll be responsible for the cost of the service. Inpatient care, physical therapy and gastric bypass surgery also require authorization.

What type of care can I receive when traveling out of state?
BCN provides routine, emergency, urgent and follow-up care through BlueCard®, a Blue Cross and Blue Shield Association program that gives members access to physicians anywhere in the United States (outside of Michigan) where a Blue plan is offered.

How is coverage handled when I am traveling out of the United States?
BCN handles coverage when traveling out the United States through BlueCard.  Members are usually required to pay up front for service and then are reimbursed. Any questions regarding the BlueCard program can be answered through the BCN Customer Service at 1-800-662-6667.

Will my out-of-state claims be payable in-network or out-of-network?
Services received from a participating Blues provider through BlueCard are payable at in-network benefit levels.

My child is going away to school next year. What type of coverage will my child receive?
In the BCN Michigan service area, BCN can help you find a participating physician at your destination. Outside of Michigan, BCN can help you find a participating Blues provider. Services received from Blues providers are covered at in-network benefit levels.

How do I find out if my current doctor is part of the BCN network?
Log on to our website any time day or night and open the physician selection tool (http://www.bcbsm.com/index/common/find-a-doctor.html) to search for and select physicians. You can also call Customer Service at 1-800-662-6667 from 8 a.m. to 5:30 p.m. Monday through Friday. TTY users can call 1-800-257-9980.

What if my doctor isn’t part of the network?
You can continue treatment with any provider whether or not he or she participates with BCN. In order to decrease your out-of-pocket costs, you should seek treatment with a BCN participating provider. Certain services and treatment from non-participating providers can be considered for continuity of care. You can contact BCN Customer Service at 1-800-662-6667 to initiate a continuity of care request.

Do I need a referral to get specialty care?
No, but you must have BCN authorization before you get care from providers who aren’t part of the BCN network. You are responsible for getting this authorization by calling 1-800-392-2512. If you receive medical care from providers who aren’t part of the BCN network without BCN authorization, you will be responsible for the cost of the service. Also, some in-network and out-of-network covered health services must be authorized by BCN before you receive them. These include inpatient care, physical therapy and gastric bypass surgery.

Does BCN mail Explanation of Benefit statements?
If you receive a service and are responsible for a deductible or coinsurance amount, BCN will send you an Explanation of Benefit (EOB) Payment statement. You can also view your claim information (and opt-out of paper EOBs) by logging in to Member Secured Services at http://www.bcbsm.com/.

Do I pay a copayment for emergency care?
There’s no copayment if you’ve been admitted to the hospital.  In addition, the emergency co-pay may be waived based on "signs and symptoms" and if the emergency is due to an accident.  However, there is a copayment if the event turns out to be non-emergent. 

How do I get my medical claims reimbursed?
When you receive covered medical and behavioral health services, you may be responsible for a deductible before BCN payments begin. You may also have to pay any required copayment at the time of service. The doctor, hospital or other health care provider will bill BCN for covered services.

What do I do if I have issues about my care?
If you have a concern about your care, discuss this with your primary care physician first. You can call Blue Care Network Customer Service at 1-800-662-6667 with any question or problem you have. BCN Service Company partners with BCN to support your coverage with customer service and appeals and grievances. If you’re not able to resolve your issue by calling BCN, BCN has a formal process you can use. You have two years from the date of discovery of a problem to file a grievance or appeal a decision of BCN Service Company. There are no fees or costs.

Do I need to tell BCN if I have other health insurance in addition to BCN?
Yes. BCN coordinates your benefits with other insurers to make sure you get maximum coverage. Coordination of benefits also helps BCN keep down the cost of health care. Periodically, BCN will send you a coordination of benefits questionnaire to complete, asking for information about other health insurance. BCN needs this information before we can process your claims.

What programs does BCN offer to assist me with health issues (disease management programs)?
BlueHealthConnection® disease management programs provide the information and people to help you manage your condition and achieve the best possible quality of life. BCN offers programs for: asthma, cardiovascular heart disease, chronic kidney disease, chronic obstructive pulmonary disease, depression, diabetes and heart failure.

Does BCN offer any money-saving programs?
BCN Service Company and BCN can help you stay healthy and save money at the same time through:

Healthy Blue XtrasSM, a Blues program with special offers from companies across Michigan. Savings cover a variety of healthy goods and services from groceries and fitness gear to yoga and gym packages.

Blue365®, a program sponsored by the Blue Cross and Blue Shield Association, with savings on such things as fitness centers, weight control programs, recreation and alternative medicine. Blue365 also provides helpful resources that allow you to make informed health care decisions.

How do I identify the participating urgent care centers with Blue Care Network?

Log on to the BCN web site at http://www.bcbsm.com/ to look up urgent care centers. BCN encourages members to seek urgent care services from contracted providers but if it is not convenient for you then you can seek services at any urgent care center in Michigan and your claims will be processed at the in-network benefit level.

Are there any restrictions to obtaining health coverage if I have any existing medical condition and I want to change health plans?

No, there are no pre-existing condition restrictions with Community Blue, Blue Care Network, BCBSM Traditional or BCBSM Transition health plans.


Deductibles

What is a deductible?
A deductible is a set dollar amount that enrollees must pay out-of-pocket toward certain health care services before insurance starts to pay.

Which of the MSU health plans have deductible requirements and do those requirements vary by employee type?
Under the BCN plan all enrollees will have an in-network and out-of-network deductible for certain types of services. Under the Community Blue PPO, Pre-Medicare (under 65) executive staff, faculty and academic staff retirees have an in-network deductible and an out-of-network deductible, and support staff retirees only have an out-of-network deductible. There are deductibles for Master Medical on the BCBSM Traditional and Transitional plans.

What is the dollar amount of the deductible for the MSU health plans?
The BCN in-network deductible for the calendar year (January through December) will be $100 per individual or $200 per family. The BCN out-of-network deductible is $500 per individual or $1,000 per family. This deductible applies to all BCN enrollees.

The Community Blue PPO plan does not have an in-network deductible requirement for support staff retirees. The executive staff, faculty and academic staff retiree in-network deductible for the calendar year (January to December) is $100 per individual or $200 per family. The Community Blue PPO out-of-network deductible is $250 per individual or $500 per family. The out-of-network deductible applies to all Community Blue enrollees.

The deductibles for Master Medical on the BCBSM Traditional and Transition plans are $200 per individual and $400 per family.

What types of services are subject to deductible requirements and do co-pays count toward meeting deductibles?
Deductibles only apply to certain types of services and care in the MSU plans. For many types of care, no deductibles apply. Co-pays do not count toward meeting deductibles in most cases. For other types of services such as hospital care, diagnostic tests and x-rays, radiation therapy, hospice care, surgical services and other services, insurance begins paying only after deductibles for the year are met. 


Retiree Contributions

Will I have to contribute toward the cost of the health plan I choose?
MSU's contribution toward retiree health plan coverage will pay the full cost of the lowest cost health plan (and a prorated amount for those eligible for part-time contributions). The lowest cost health plan, depending on your eligibility, is either BCBS Traditional, BCBS Transition or BCN. If you are enrolled in Community Blue, the higher cost plan, you will contribute the premium cost difference between Community Blue and either BCBS Traditional, BCBS Transition or BCN.

I am a retiree, not yet eligible for Medicare, with a family member enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage?
Retirees with a family member enrolled in Medicare may choose between the Blue Cross Blue Shield Transition plan or BCN. The full university contribution toward retiree health plan coverage pays the full cost of the BCBS Transition coverage for eligible retirees, their spouses and their dependents (prorated for part-time). Retirees who select BCN must pay the premium difference between BCN and BCBS Transition plan (the lowest cost plan).  For more details please review the health plan contribution rates in the Retiree Open Enrollment Guide.

Coverage Tier BCBS Transition BCN Faculty & Support Staff
2 Person, 1 with Medicare -0- $155.95
Family, 1 with Medicare -0- $390.88
Family, 2 with Medicare -0- $640.85

I am a retiree not enrolled in Medicare with no family member(s) enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage?
Retirees without any family member(s) enrolled in Medicare may choose between the Community Blue or BCN health plans. The current university contribution toward retiree health plan coverage pays the full cost of BCN (the lowest cost health plan). Retirees who select Community Blue must pay the premium difference between the cost of BCN and Community Blue. For more details please review the health plan contribution rates in the Retiree Open Enrollment Guide.

I am a retiree enrolled in Medicare and my spouse is also enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage?
Retirees with all family members enrolled in Medicare may choose between the Blue Cross Blue Shield Traditional or BCN health plans. The current university contribution toward retiree health plan coverage pays the full cost of BCBS Traditional coverage for retirees, their spouse and their dependents (prorated for part-time). Retirees who select BCN must pay the premium difference between BCN and BCBS Traditional plan.   For more details please review the health plan contribution rates in the Retiree Open Enrollment Guide.


Coverage Options

I am an MSU retiree with Medicare and all of my enrolled family members also have Medicare. What health coverage options can I choose from?
You have a choice between the Blue Cross Blue Shield Traditional Plan and BCN.

I am an MSU retiree and all members of my family (including me) are not enrolled in Medicare. What health coverage options can I choose from?
You have a choice between the BCBS Community Blue Plan and BCN for you and any family members you enroll. In the future, when you or any family member becomes covered under Medicare, you may be required to cover everyone in the family under either BCN or the BCBS Transition Plan.

I am an MSU retiree and the members of my family are a mix of Medicare and non-Medicare enrollees. What health coverage options can I choose from?
You have a choice between the BCBS Transition Plan and BCN. In the future when all members of the family have Medicare, you may be required to select either the BCBS Traditional Plan or BCN.


Access to MSU Health Plan Coverage for Spouse or Other Eligible Individual

My spouse or Other Eligible Individual (OEI), who works for another employer or is retired, is eligible to purchase single health plan coverage for a premium contribution of $850 or less per year from that employer. What do I need to do?

  • Participate in the online Open Enrollment
  • Complete a Health Plan Affidavit
  • If the spouse/OEI is eligible to purchase single health plan coverage for $850 or less, the spouse/OEI MUST enroll in their employer’s health coverage.

My spouse or Other Eligible Individual, who works for another employer or is retired, is eligible to purchase single health plan coverage for a premium contribution of more than $850 per year from that employer. What do I need to do?

  • Participate in the online Open Enrollment
  • Complete a Health Plan Affidavit
  • If the cost for purchasing single health plan coverage to the spouse/OEI is more than $850, the spouse/OEI does NOT have to enroll in their employer’s health coverage.

My spouse or Other Eligible Individual does not have access to other health plan coverage. Do I still need to complete the Health Plan Affidavit for Spouse or Other Eligible Individual?
Yes, you still need to complete a Health Plan Affidavit.

My spouse or Other Eligible Individual currently works for another employer and is required to take that employer's health plan coverage. Is my spouse or Other Eligible Individual also required to cover our dependent children under his/her employer's health plan?
No, MSU does not require your dependent children to be covered under your spouse's or Other Eligible Individual's employer's health plan. However, you may wish to have them covered under the other employer's plan depending on your cost for this coverage and your health plan needs.

When does my spouse or Other Eligible Individual need to enroll in their employer's health plan?
No later than July 1 during the year of MSU's Open Enrollment.


CVS Caremark Prescription Drug Plan

Do I need to enroll in the CVS Caremark prescription drug plan if I change health plans?
No, if you are enrolled in any of the MSU health plans, you'll automatically be covered by the CVS Caremark prescription drug plan.



Health Care Reform (also known as the "Patient Protection and Affordable Care Act")

How will the Health Care Reform changes (also known as the "Patient Protection and Affordable Care Act") affect me?
Effective July 1, 2011, there will be several changes to our health plans (i.e., your dependents will be able to be covered on your health plan through the calendar year they turn age 26, no lifetime plan maximums, no co-pays or co-insurance on preventative services, etc.).  Please see the health plan comparison for more information.

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