Health Plan PPO | State of Michigan Employees

The flexibility to see specialists without a referral from a primary care provider
Staying inside the network means lower out-of-pocket costs
Many services are covered outside of your network for higher out-of-pocket costs

In-network Individual Deductible

$400

In-network Family Deductible

$800

Telehealth services
Value-added services such as Blue Cross Coordinated Care, Blue Cross Health & Well-Being^SM and 24-Hour Nurse Line
Manage your account 24 hours a day, seven days a week with the BCBSM app

See what's covered and how much you'll pay.

In-network deductible

$400 per individual, $800 per family

In-network out-of-pocket maximum

$2,000 per individual, $4,000 per family

Office visit copay

$20

Coinsurance

10%

$400

$800

$1,600

$2,000

$3,000

$4,000

$6,000

10% for most services

20% for most services

$20

80% after deductible

$200 copay (waived if admitted as inpatient)

90% after deductible

80% after deductible


	$400	$800
	$800	$1,600
	$2,000	$3,000
	$4,000	$6,000
	10% for most services	20% for most services
	$20	80% after deductible
	$200 copay (waived if admitted as inpatient)	$200 copay (waived if admitted as inpatient)
	90% after deductible	80% after deductible

State Health Plan PPO