Healthy Blue ChoicesSM POS is a point-of-service product for FCA non-bargaining employees and retirees that is administered by Blue Care Network. Healthy Blue Choices POS allows the flexibility to receive covered health care services in or out of network without a referral. FCA bargaining employees are covered under a separate health plan administered by BCN. Only Healthy Blue Choices is described here.
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
- Some services are not handled through Blue Care Network
Healthy Blue Choices 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 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 Healthy Blue Choices member (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||Healthy Blue Choices 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 for Michigan providers (PDF)|
|Any state other than Michigan||Any state, including Michigan||In or out of network||Non-Michigan providers: BCN referral and authorization requirements (PDF)|
Requirements for selecting a primary care provider
Healthy Blue Choices 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.
Healthy Blue Choices 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:
- Healthy Blue Choices 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.
- Healthy Blue Choices 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.
When a dependent is enrolled in Healthy Blue Choices 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:
|Healthy Blue Choices member (dependent) enrolled address location||Member's assigned PCP performs office visit in this location||A PCP-like BlueCard traditional-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.||Office visits are not covered|
*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 for examples). But there are also preventive services that members can receive from in- or out-of-network providers (see the B list for examples). Be sure to check each member's benefits through our provider portal (availity.com)** or by contacting Provider Inquiry,
A. Examples of services covered from in-network providers only
- Some preventive services
- Office visits
- Routine prenatal care — For members with active employee coverage (subscriber ID prefix XYS)
- Colonoscopy — For members with retiree coverage (subscriber ID prefix XYD)
- Durable medical equipment
- Prosthetics and orthotics
- Diabetes supplies
- Outpatient rehabilitation (physical therapy, occupational therapy, speech therapy)
- Hearing aids
B. Examples of preventive services covered in and out of network
- Colonoscopy — For members with active employee coverage (subscriber ID prefix XYS)
- Shingrix and Zostavax® immunizations
- Voluntary female sterilization
- Routine postnatal visits
You can access a list of preventive service procedure codes that comply with the Affordable Care Act and are effective for Healthy Blue Choices members with active employee coverage (subscriber ID prefix XYS). Follow these steps:
- Log in to our provider portal (availity.com)**.
- Click Payer Spaces on the Availity menu bar.
- Click the BCBSM and BCN logo.
- Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab.
- Click Preventive Benefits on the Member Care tab.
If you do not have access to our provider portal, call the Provider Inquiry number below.
Some services are not handled through Blue Care Network
Some services are handled through specific vendors not associated with Blue Care Network.
- Behavioral health services — Contact Carelon Behavioral Health (number on back of ID card)
Exception — The following services are covered through Blue Care Network:
- Certain services for patients with an autism diagnosis. Specifically:
- Occupational, speech and language and physical therapy performed by a licensed, certified therapist for PT, OT, ST
- Nutritional therapy
- Genetic testing
- Claims with a medical primary diagnosis code
- Developmental screening
- Emergency services, ambulance, outpatient radiology, outpatient rehabilitation and outpatient laboratory services with a behavioral health primary diagnosis
- Neuropsychological exams and ancillary services such as evaluations and interviews
- Psychiatric diagnostic evaluations
- Infertility treatment services — Member has coverage through separate vendor.
Exception — The following services are covered through Blue Care Network:
- Infertility diagnosis
- Infertility medical counseling
- Treatment for the underlying causes of infertility
- Pharmacy — Member has separate ID card for pharmacy
For questions about Healthy Blue Choices 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.