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Health insurance

University faculty and staff eligible for benefits may enroll themselves and their eligible dependents in the Community Blue PPO health plan, administered by Blue Cross Blue Shield of Michigan (BCBSM).

Your Benefits Guide

Provided by BCBSM, Your Benefits Guide provides information on how to use the Community Blue PPO, benefits and services covered by the plan, and ways you can minimize out-of-pocket medical costs. Details of your prescription drug, dental, and vision coverage are also included in this guide. [Please note: this new guide replaces both the "Health Insurance Benefits Summary" and "BCBS Benefits Guide" previously available via this Web page.]

Community Blue PPO network providers

Members can find Community Blue PPO network providers on BCBSM's Where You Can Go For Care Web page. Search for physicians, hospitals, and other health care providers in the PPO network. Members can also search for providers who participate in BCBSM's traditional network.

Coverage varies by provider type as follows. Par providers are those who participate with BCBSM.

In-Network Vs Out-of-Network Coverage: Par Vs Non-Par
Provider Type	PPO In Network	Traditional BCBSM, out-of-network, with referral	Traditional BCBSM, out-of-network, no referral	Non-Par BCBSM, out-of-network, with referral	Non-Par BCBSM, out-of-network, no referral
Coverage	100% after in-network deductible	100% after in-network deductible	80% after out- of-network deductible	100% of approved charge, after in-network deductible; employee liable for balance	80% of approved charge, after out-of-network deductible; employee liable for balance

On-campus health care

Health care services are also available on campus at Sindecuse Health Center and WMU Unified Clinics to members of the Community Blue PPO through the WMU Health Services Plan: or .

Prescription drug coverage

Your prescription drug benefit is provided through BCBSM's 90-day retail prescription drug program. Under this program, members are able, with proper prescription, to obtain a 90-day supply of a medication for a single co-payment at a participating pharmacy. Sindecuse Health Center pharmacy participates in the program.

The benefit has the following provisions:

• The co-payment is determined by the three-tier structure of generic ($15), formulary brand ($25), and non-formulary brand ($35). These co-payments are $10, $20, and $30, respectively, at Sindecuse.
• The member must have been on the medication for at least 60 days out of the previous 120 days, as demonstrated by pharmacy fills, before being eligible for a 90-day supply.
• The member may continue to obtain a 34-day supply of a medication from a 90-day retail network provider.
• New prescriptions filled at Sindecuse require two initial fills in a 34-day supply, each for a $2.50 co-payment regardless of tier.
• The written prescription must specify a quantity greater than an 83-day supply, up to a 90-day supply. Claims for supplies of 35 to 83 days will be rejected.

Your Benefits Guide contains detailed information about your prescription drug coverage. You may also find the following Web links helpful:

BCBSM 90-day Retail Prescription Program

BCBSM Approved Drug Lists (Formularies)

Sindecuse Pharmacy - WMU Employees

The following retail chains offer select prescription drugs at a discount or for free:

Meijer Pharmacy: Free Antibiotics

Target Pharmacy: $4 Generic Drugs

Wal-Mart Pharmacy: $4 Prescriptions Program

Submitting claims

Typically, in-network providers submit your claim for you; some out-of-network providers may also do so. For claims that you must submit yourself, send them to:

Attn: WMU Claims
Blue Cross Blue Shield of Michigan
PO Box 230555
Grand Rapids, MI 49523-0555

Pre-addressed claim envelopes are available for pick-up in Human Resources.

Need help?

Contact Blue Cross Blue Shield of Michigan for coverage and claims information concerning the Community Blue PPO:

• BCBSM Customer Service: (800) 879-1945
• A BCBSM representative is available to meet with employees in Human Resources each Thursday. Please call Human Resources to make an appointment.

Additional resources

Frequently asked questions

The Health Insurance Portability and Accountability Act (HIPAA) establishes certain privacy rights regarding employees' personal health information. Detailed Information is located in the Human Resources Policies and Procedures Manual's Health Insurance Portability and Accountability Act (HIPPA) Section.