Blue Elect Plus^SM POS, Blue Elect Plus HSA^SM POS, and Blue Elect Plus HRA^SM POS are Blue Care Network point-of-service products that allow the flexibility to receive covered health care services in or out of network without a referral. Employers that offer a Blue Elect Plus product to their employees located in Michigan may also offer this product to employees who live outside of Michigan.

On this page you'll find information on:

• Referral requirements
• Authorization requirements
• Requirements for selecting a primary care provider
• What members pay
• Some services are covered only from in-network providers
• Questions

Referral requirements

Blue Elect Plus members don't need a referral for any covered service. They can refer themselves to any provider — even to providers who are considered out of network for this product.

When members get care from out-of-network providers, they pay higher out-of-pocket costs for covered services. Refer to the “Requirements for selecting a primary care provider” section below for more information.

Authorization requirements

• Providers located in Michigan follow the authorization rules outlined in the BCN referral and authorization requirements for Michigan providers document (PDF). These rules apply to Michigan providers whether they are contracted with BCN or not.
• Providers located outside of Michigan follow the authorization rules outlined in the Non-Michigan providers: BCN referral and authorization requirements document (PDF). These rules apply to non-Michigan providers whether they participate with a BlueCard^® Traditional plan or not.

Note: A BlueCard Traditional-participating provider is one who's contracted with their local Blue Cross Traditional plan.

Providers must follow these authorization requirements regardless of whether the Blue Elect Plus member (subscriber or dependent) is enrolled at a Michigan address or at an address outside of Michigan.

See the table below for some examples of which authorization rules apply.

Requirements for selecting a primary care provider

Blue Elect Plus members enrolled with a Michigan address must select a BCN primary care provider, but they still have the option to seek care from other physicians and specialists without a referral.

Blue Elect Plus members enrolled with a non-Michigan address don't need an assigned primary care provider. They also don’t need a referral; they just need to see a BlueCard Traditional-participating provider if they want to pay the lower in-network out-of-pocket costs.

What members pay

The member's out-of-pocket costs vary depending on whether they're getting care from an in-network or out-of-network provider:

• Blue Elect Plus in-network providers are providers contracted with BCN HMO and non-Michigan providers who participate with a BlueCard Traditional plan. Members pay less out of pocket when they're seen by these providers.
• Blue Elect Plus out-of-network providers are:
  • Michigan providers who are not contracted with BCN
  • Non-Michigan providers who do not participate with a BlueCard Traditional plan. Members may get care from out-of-network providers for covered services, but they'll pay more.

  Members may get care from out-of-network providers for most covered services, but they'll pay more. See the section "Some services are covered only from in-network providers" for a list of services that require an in-network provider.

Note: Some members may be covered outside Michigan only for urgent and emergency services. Be sure to check each member’s eligibility through our provider portal (availity.com**) or by contacting Provider Inquiry at the number below.

When a subscriber or dependent is enrolled in Blue Elect Plus with a non-Michigan address and receives care through an office visit with a "PCP-like" BlueCard Traditional-participating provider outside of Michigan, they'll pay either the PCP copay or the specialist copay; this depends on the member's enrolled address and the provider's location. PCP-like providers are BlueCard Traditional-participating family medicine, general practice, pediatrics and internal medicine providers outside of Michigan that also include nurse practitioners for adult health, family, gerontology, pediatrics and primary care.

See the table below for some examples of the out-of-pocket costs a member will pay:

*In Michigan, only BCN-contracted providers are in network, for purposes of determining the member's out-of-pocket costs.

Some services are covered only from in-network providers

Some services are covered only when received from an in-network provider (see the A list). But there are also preventive services that members can receive from in- or out-of-network providers (see the B list).

A. Services covered from in-network providers only

• Most preventive services as defined by the Affordable Care Act (see List B, which follows, for exceptions)
• Infertility counseling and treatment
• Adult sterilization
• Durable medical equipment
• Prosthetics and orthotics
• Diabetic supplies
• Weight reduction procedures
• Chiropractic services

B. Preventive services covered in and out of network

• Flu vaccine
• Colonoscopy
• Mammography
• Routine prenatal care

You can access a list of preventive service procedure codes that comply with the Affordable Care Act by completing these steps:

1. Log in to our provider portal (availity.com)**.
2. Click Payer Spaces on the Availity menu bar.
3. Click the BCBSM and BCN logo.
4. Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab.
5. Click Preventive Benefits on the Member Care tab.

If you do not have access to our provider portal, call the Provider Inquiry number below.

Questions?

For questions about Blue Elect Plus POS, Blue Elect Plus HSA POS, and Blue Elect Plus HRA POS, call Provider Inquiry:

• Physicians/professionals: 1-800-344-8525
• Hospitals/facilities: 1-800-249-5103

** Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're required to let you know we're not responsible for its content.