May 7, 2021, Blue Cross Blue Shield Settlement Notice
A law firm representing plaintiffs in a lawsuit against the Blue Cross Blue Shield Association (BCBSA) mailed a notice regarding an antitrust settlement to people who were members of BCBS health plans between 2008 and 2020. This settlement involves BCBS plans on a national level.
If you receive a notice, keep in mind that settlement payments for self-funded groups like the U-M plans will total $120 million and will likely be divided among millions of BCBS members across the country who are eligible to file a claim. Claims for damages for members of self-funded groups is for enrollment between September 1, 2015 and October 16, 2020.
Your choice to participate or not to participate in this settlement has no impact on your coverage in U-M health plans or any services covered under the terms of the plans.
The University of Michigan is unable to answer questions about the lawsuit or settlement. Contact JND Legal Administration directly with any questions or concerns. Visit www.BCBSsettlement.com, email info@BCBSSettlement.com, call (888) 681-1142, or write to Blue Cross Blue Shield Settlement c/o JND Legal Administration, P.O. Box 91390, Seattle, WA 98111.
About U-M Health Plans
The University of Michigan offers a choice of health plans as part of a high-quality benefits package that helps you stay well and protect yourself and your family.
Eligible employees and retirees can select from Comprehensive Major Medical, U-M Premier Care and Community Blue PPO. A new managed care option, Michigan Care, is available for 2021. Eligibility for the plan is limited to those who live in the service area.
GradCare is offered for benefits-eligible graduate students only.
Prescription drug coverage is included when you enroll in any U-M health plan.
Health Plan ID Cards
When you enroll in a U-M Health Plan, the health plan company will mail an ID card to your home address on file. You will also receive a separate ID card from Magellan Rx for prescription drug coverage. If you do not receive your ID card within 4-6 weeks after enrollment, call the health plan company directly to request a card. If you enrolled in a U-M health plan and need health care services before receiving your ID card, call the health plan company directly and ask about the reimbursement procedure. Until you receive your card, you may need to pay for services in full and then file for reimbursement from your health plan company. Be sure to save all receipts. Health plan phone numbers are included on the individual health plan pages on the UHR website, and on the Profiles page of the 2020 health plan coverage comparison chart.
Choosing a Plan
We want to help you find the health plan that offers the most advantages to you and your family, and then to use it wisely. Before choosing a plan, consider all the costs involved (including both premiums and out-of-pocket expenses like deductibles, coinsurance, and copays), access to doctors and hospitals, and your anticipated health and financial needs over the next year. Please note that there is no out-of-pocket cost to you for preventive care under any U-M health plan. View your health plan rates.
Health Plan Coverage Comparison
For a detailed comparison, use the Health Plan Coverage Comparison tool, or view the health plan coverage comparison chart.
Health Plan Video
To help you better understand your U-M health plan choices, view a two-minute video: A Quick Guide to Your U-M Health Plan Options.
Note: This video is intended for faculty, staff and retirees who are eligible for the university's health plans. An additional health plan, Michigan Care, not mentioned in the video is available for those who live in the plan's service area. View the Michigan Care video.
If you are a benefit-eligible graduate student, including Graduate Student Instructor (GSI), Graduate Student Staff Assistant (GSSA), Graduate Student Research Assistant (GSRA), benefit-eligible fellowship holder, or medical school student, please visit GradCare to learn about your university health plan option. If you are U-M student and not eligible for GradCare, you may be eligible to enroll in the domestic student health insurance plan.
|Type of Expense||Comprehensive Major Medical (BCBSM)||Michigan Care (PHP)||U-M Premier Care (BCN)||Community Blue PPO (BCBSM)|
|Office visit copay||Deductible and coinsurance apply||$25||$25||$25|
|Specialist visit copay||Deductible and coinsurance apply||$30||$30||$30|
|Coinsurance||20% after deductible||$0||$0||50% if out of network|
*No deductible in U-M Premier Care Network 1. $2,000 individual/$4,000 family deductible in Network 2.
|Plan Feature||Comprehensive Major Medical (BCBSM)||Michigan Care (PHP)||U-M Premier Care (BCN)||Community Blue PPO (BCBSM)|
|You must select a primary care physician||No||Yes||Yes||No|
|You can visit any doctor||Yes||No||No||Yes|
|You need a referral to visit a specialist||No||Yes||Yes||No|
|You can use out-of-network providers||Yes, but will pay more||No||No||Yes, but will pay more|
|You are required to live in a particular service area||No||Yes, check your eligibility||Yes*||No|
|Coverage is available for dependents who live in a different location||Yes||Yes, with approval from PHP||Yes, with approval from BCN||Yes|
*U-M Premier Care Provider Network 1 service area: Genesee, Livingston, Macomb, Oakland, Washtenaw and Wayne counties, and portions of Ingham, Jackson, Lapeer, Monroe and St. Clair counties.
Health Plan Definitions
- Coinsurance refers to your share of the cost of a covered health care service, calculated as a percent of the allowed amount for the service (for example, 20%). You pay coinsurance in addition to any deductible you owe for your plan. The health plan pays the rest of the allowed amount.
- A copay is a fixed dollar amount (for example, $25) you pay for a covered health care service, such as an office visit, at the time you receive the service. The amount can vary by the type of service.
- Your deductible is the amount you owe for health care services before your health plan begins to pay. For example, if your deductible is $500, your plan won’t pay anything until you have paid $500 out-of-pocket for covered health care services subject to the deductible. The deductible may not apply to all services.
- The premium is the amount that must be paid for your health plan. You pay a portion of the monthly health plan premium through automatic payroll deductions.
- Preventive Care Services
- Under the Affordable Care Act, all U-M health plans cover a set of preventive services — like blood pressure screening and cholesterol screening — at no cost to you. These services are free only when delivered by a doctor or other provider in your plan’s network. There are three sets of preventive health services: for all adults, for women, and for children. For more information, visit HealthCare.gov.
Pair Your Health Plan with a Flexible Spending Account
You may want to consider a pre-tax health care Flexible Spending Account (FSA) to complement your health plan, particularly if you choose an option with higher out-of-pocket expenses.
Health Coverage while Traveling Abroad
Faculty and staff traveling on international university-related business are automatically covered at no cost by travel abroad health insurance. Learn more about your coverage during international business travel.
Coverage for Services Related to Infertility
All U-M health plans cover services related to infertility. Some services will only be covered if provided by the Michigan Medicine Center for Reproductive Services. The U-M Prescription Drug Plan, which covers outpatient prescription drugs for all members enrolled in U-M health plans, provides coverage for self-administered infertility medications within limits specified by the plan. Learn more about coverage for services and prescriptions related to infertility.
All U-M health plans cover medically necessary gender-affirming services for members with gender dysphoria, following standards of care from the World Professional Association for Transgender Health. The Benefits Office has designated a specific staff member who is a member of the LGBT Ally Program and is knowledgeable about and sensitive to the unique benefit related issues that transgender members of our community may encounter. Faculty and staff with questions about benefit issues related to transgender status are encouraged to contact Brian Vasher at firstname.lastname@example.org.