Blue icon of a hand holding a box with a check mark in it.

Blue Elect Plus POS: Member and Service Information

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:

Blue Elect Plus member (subscriber or 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
Michigan Michigan N/A Yes PCP copay
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
  • 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.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.