Blue Elect PlusSM POS and Blue Elect Plus HSASM POS are 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
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.
- Providers located in Michigan follow the authorization rules outlined on the BCN Referral and Authorization Requirements document. These rules apply to Michigan providers whether they are contracted with BCN or not.
- Providers located outside of Michigan follow the authorization rules outlined on the Non-Michigan providers: Referral and authorization requirements document. These rules apply to non-Michigan providers whether they participate with BlueCard® or not.
Note: A BlueCard-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.
|Provider's location||Blue Elect Plus member (subscriber or dependent) enrolled address location||Provider's network status||Which authorization rules apply|
|Michigan||Any state, including Michigan||In or out of network||BCN Referral and Authorization Requirements|
|Any state other than Michigan||Any state, including Michigan||In or out of network||Non-Michigan providers: Referral and Authorization Requirements|
Requirements for selecting a primary care provider
Blue Elect Plus members enrolled with a Michigan address must select a BCN HMO 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-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 out-of-state providers who participate with BlueCard. 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 BlueCard. 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.
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-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-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:
|Blue Elect Plus member (subscriber or dependent) enrolled address location||Member's assigned PCP performs office visit in this location||A PCP-like BlueCard participating provider outside of Michigan performs the office visit in this location||Member PCP requirement||Member pays|
|N/A||Any state other than Michigan||Yes||Specialist copay|
|Any state other than Michigan||N/A||Any state other than Michigan where the member resides||No||PCP copay|
|N/A||Michigan (from a BCN-contracted provider)**||No||Specialist copay|
|N/A||Any state other than Michigan where the member does not reside||No||Specialist copay|
|Office visit provided by an out-of-network provider, regardless of where the member lives or receives care.||Out-of-network cost share|
**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
- Routine prenatal care
You can access a list of preventive service procedure codes that comply with the Affordable Care Act by completing these steps:
- Log in as a provider at bcbsm.com.
- Click BCBSM Provider Publications and Resources (on the right)
- Click Newsletters & Resources (on the left).
- Click Preventive Services (on the left).
- Click Preventive service procedure codes with no member cost-sharing.
If you do not have access to Provider Secured Services, call the Provider Inquiry number below.
For questions about Blue Elect Plus POS and Blue Elect Plus HSA POS, call Provider Inquiry:
- Physicians/professionals: 1-800-344-8525
- Hospitals/facilities: 1-800-249-5103