Changes to BCBS PPO plan

Changes Effective Jan. 1, 2018

Starting in 2018, changes will affect some employees covered by Western Michigan University’s Community Blue PPO plan when they receive services at the health center. These changes affect faculty and staff in AAUP and non-bargaining employee groups, their retirees, surviving spouses and their covered dependents:

  • $30 copay collected for non-specialty office visits 
  • Deductible charges at Sindecuse will be capped at 50% of the PPO plan 
  • Some preventive care visits do not require a copay

These changes do not apply to AFSCME or MSEA employee groups in the Community Blue PPO plan.

Pharmacy

  • New copays amounts will apply to 30-day prescriptions: 
    • Tier 1 – $10 (generic)
    • Tier 2 – $30 (preferred brand)
    • Tier 3 – $60 (non-preferred brand)
    • Tier 4 – 15% to $120 max. (preferred specialty, 15 or 30-day supply)
    • Tier 5 – 20% to $240 max. (non-preferred specialty, 15 or 30-day supply)
  • 90-day supplies will cost 2.25 times the 30-day supply for tiers 1, 2, and 3
  • Some prescriptions will require pre-authorization. Patients may experience additional wait time while Blue Cross Blue Shield delivers a response. 

Lab and X-ray

  • We send most lab work to Borgess for testing 
  • Lab services not covered by insurance will be billed to the patient by Borgess
  • In the PPO plan, a patient is responsible for the full amount of diagnostic services until a deductible is met, then 10% coinsurance (20% coinsurance for aviation associates or R3 research associates)

Sports Medicine Clinic

  • $40 copay collected for sports medicine doctor, podiatrist, and orthopedic specialist visits
  • Physical therapy and massage therapy – no copay, patient pays full amount until deductible is met, then 10% coinsurance (20% coinsurance for aviation associates or R3 research associates)

At checkout 

Patients responsible for a copay may choose to pay at checkout or charge to payroll deduct. To set up payroll deductions, fill out the payroll deduction enrollment form and return it completed to Sindecuse staff.

After a visit

  • Patients will receive an Explanation of Benefits (EOB) from Blue Cross 
  • The University will send an invoice with a line that reads "Health Center" for charges not covered by insurance
  • WMU adds a late fee to balances not paid on time, and a convenience fee for payments made by credit card

Not changing at Sindecuse

Some services continue to be covered by WMU's PPO insurance and WMU at no cost to patient

  • Nutrition counseling by a Registered Dietitian
  • International travel immunizations
  • Pre-participation physicals
  • Diabetic medical supplies

AFSCME and MSEA member employees, their retirees and surviving spouses will continue Community Blue PPO benefits with no change from 2017.

HMO ELIGIBILITY

WMU employees on the Healthy Blue Living HMO plan offered by Blue Care Network are invited to use Sindecuse pharmacy services, but should note that copays are different than the PPO plan. HMO members are not covered by insurance for any other health center services.

advantages to using Sindecuse

  • For services received at Sindecuse, the deductible is only 50% of the in-network plan deductible
  • We offer low-cost brand name prescriptions and over the counter medications
  • Quick access to appointments with caring clinicians, sports medicine doctors, physical therapists, massage therapists and athletic trainers
  • Laboratory and X-ray services on site
  • Outside prescriptions, and lab or X-ray orders for  services accepted
  • No-cost workshops and resources on health education, wellness topics 
  • Convenient one-stop location on campus means less time in traffic, fewer stops to get medical care and diagnostic services, prescriptions

More Information

Our dedication to health care excellence and service to WMU students, faculty and staff does not change. We are committed to your health and academic success in the new year. For more information about insurance benefits, employees should consult the human resources website  or call HR at (269) 387-3620 for more details.