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Questions and Answers
Individual Medical Plans
- Do I have to be a Michigan resident to apply for coverage?
- What is an effective date?
- When will I get my ID card?
- Can I download or print my application?
- What happens if my application is rejected?
- When will I get my Blue Cross Blue Shield of Michigan (BCBSM) ID card?
- Tell me about BCBSM.
- Are conditions such as allergies, chiropractic and maternity care covered under this plan?
- How do I know if I can declare my child as a dependent?
- How do I know what the co-pays and benefits are for each plan?
- How do I find out about hospitalization, preventative care and prescriptions?
- What is a PPO doctor and facility?
- Who do I call with questions regarding my policy?
- Who is eligible for coverage with these plans?
- Why does it matter if I have previous BCBSM coverage?
- Can I be denied coverage because of a medical condition?
- Is there a pre-existing waiting period?
- What is the difference between Group Conversion and Nongroup coverage and why are the monthly rates for group conversion lower?
- Can I cancel my coverage and reapply under my spouse?
- Can I cover my child who is over the age of 19?
- When will my coverage become effective?
- Once I enroll, can I change my mind about the plan I selected?
- Should I send a payment with my application?
- When will I make payments?
- Can I pay my premium electronically or through automatic withdrawal?
- Can I pay more or less than the amount on the billing statement?
- What happens if I’m late with my premium payment?
- If my coverage is cancelled for nonpayment, can I reapply?
- On my next birthday, I will be eligible for the next band of age rating. When will my rates change?
- Using Your Health Plan Coverage how does the Individual Blue plan work?
- Do I still have coverage if I go outside the PPO network?
- How can I find a PPO provider?
- Am I covered In-Network if I travel out-of-state?
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- Do I have to be a Michigan resident to apply for coverage?
Yes. You must be a resident of Michigan and live in the state for at least six months a year.
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- What is an effective date?
Why can’t today be my effective date? The effective date is the date your health benefits begin. BCBSM Individual Health coverage effective dates are the 1st, 10th, and 20th of each month.
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- When will I get my ID card?
About 2 weeks after your first premium payment is received by BCBSM.
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- Can I download or print my application?
Yes and after you have completed the application, please fax or mail to us. Our Fax number is (989) 790-6518.
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- What happens if my application is rejected?
If your application is rejected, we will provide the reason to you in writing.
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- When will I get my Blue Cross Blue Shield of Michigan (BCBSM) ID card?
BCBSM will mail your ID card within 30 days of receiving your first payment.
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- Tell me about BCBSM.
Originally formed as Michigan Hospital Service (Blue Cross) and Michigan Physician Service (Blue Shield) in 1939, the two plans merged in 1975 to become BCBS of Michigan. It is a not-for-profit pre-payment organization providing health care coverage to group customers and individuals.
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- Are conditions such as allergies, chiropractic and maternity care covered under this plan?
Maternity-delivery and newborn exams only are covered applicable to deductibles and co-pays. Allergy testing and chiropractic care are not covered benefits.
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- How do I know if I can declare my child as a dependent?
Dependent children are covered through the end of the calendar year in which they turn 19 years of age. They must live with the subscriber and receive more than half of their support from that subscriber. Also, if the dependent is a full-time student for least five months of the year or earns a gross income less than four times the allowable IRS personal exemption amount, the student can remain on the contract as an eligible dependent on the subscriber’s account until the end of the calendar year in which they turn 25 years of age.
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- How do I know what the co-pays and benefits are for each plan?
See the descriptions preceeding this FAQ.
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- How do I find out about hospitalization, preventative care and prescriptions?
You may call the customer service number at 1-800-869-2583 for any questions or concerns.
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- What is a PPO doctor and facility?
The Preferred Provider Organization are groups of hospitals and physicians dedicated to controlling the cost of medical healthcare. They perform services for members at a cost which is less that of other providers in the area. A member using a PPO network for medical services can expect quality care with less out-of-pocket expense.
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- Who do I call with questions regarding my policy?
BCBSM offers a telephone hot line number to all of their members. They can be reached by calling 1-800-869-2583. You can also contact us at (989) 790-0566.
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- Who is eligible for coverage with these plans?
Any one who is not eligible to participate in a group sponsored health plan and considered to be a Michigan resident may apply.
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- Why does it matter if I have previous BCBSM coverage?
If you have previous BCBSM coverage, your pre-existing waiting period may be waived.
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- Can I be denied coverage because of a medical condition?
Blue Cross and Blue Shield of Michigan individual health care plans are not medically underwritten. This means you will not be excluded from coverage because of medical history or current health status.
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- Is there a pre-existing waiting period?
The Nongroup IC Blue coverage requires a 180-day pre-existing exclusion period. This means if you had a medical condition for which medical advice, care or treatment was recommended or received 180 days before your enrollment date, any services you receive to treat that condition within the first 180 days after your enrollment date will not be paid by your nongroup coverage.
Note: You may be eligible to receive credit for prior health care coverage if you meet the criteria stated in the Application for Enrollment form.
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- What is the difference between Group Conversion and Nongroup coverage and why are the monthly rates for group conversion lower?
Individuals converting to IC Blue from a BCBSM group plan are referred to as Group Conversion. Individuals can convert when group health care coverage through an employer expires or is terminated. Nongroup coverage is offered to those individuals who are not eligible for group coverage through their employer or their spouse’s employer and who are not enrolled in Medicare.
Group Conversion rates are subsidized by most of our group customers, so the rates are less than those for Nongroup. If you have questions about whether you, or a family member, are eligible for the Group Conversion rate, please call a BCBSM customer service representative at 1-800-869BLUE.
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- Can I cancel my coverage and reapply under my spouse?
You may cancel your coverage at any time. However, you may have a lapse in coverage and you may also be subject to the 180-day pre-existing condition waiting period. Also note that the prescription drug maximum is based on the annual payment by BCBSM for each member on the contract. The maximum will be carried over for each member, even if the member has transferred to a different contract. If you cancel your coverage under IC Blue, you may have to wait one year from the cancellation date to reapply.
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- Can I cover my child who is over the age of 19?
Yes. Coverage for dependent children beyond the end of the calendar year in which they turn 19 is available under the Family Continuation rider with the Individual Care Blue, Flexible Blue, and Value Blue plans. To receive this coverage, all of the following requirements must be met:
*Child to be covered is related to you by blood, marriage or legal adoption or guardianship.
*Child to be covered is between 19 and 25 years of age.
*Child to be covered is unmarried.
*Child to be covered lives with you, unless they reside somewhere else temporarily (as in the case of college students).
*Child to be covered receives more than half of his/her financial support from you.
*Child to be covered is a full-time student for at least five months of the year or has a gross annual income less that four times the personal exemption amount allowed by the IRS.
Young Adult Blue does not offer the Family Continuation rider, however, children over the age of 18 may enroll in their own Young Adult Blue plan independent of their parent(s) coverage. They must be unmarried and under the age of 30 to apply for coverage.
Note: Personal exemption amounts change annually. Please call the customer service center at 1-800-869-BLUE for the current amount and for additional information on payments, limitations and exclusions regarding Family Continuation coverage.
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- When will my coverage become effective?
After your application is reviewed and approved, you will receive a bill. A start date for your coverage will be assigned as close as possible to the date you requested on your application. Your coverage will become effective upon receipt of payment. If you do not receive a billing statement within 45 days of submitting your application, please contact our customer service office at 1-800-869-BLUE.
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- Once I enroll, can I change my mind about the plan I selected?
You may change your selection before your first bill is paid. However, your selection is normally effective for the 12-month period following your decision. You will be notified should special circumstances arise that allow our members to make a change in their plan outside their cycle. For more information, please contact our customer service center at 1-800-869-BLUE.
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- Should I send a payment with my application?
No, you will be billed for coverage once your application is approved and processed. Please do not send any money with your application form.
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- When will I make payments?
Bills are generated on a two month billing cycle. You must make your payment by the due date reflected on your bill in order to keep your policy active and claims paid. Although, payments not received by the due date will have a 30-day grace period, claims will not be paid until payment is received.
Note: Payments cannot be submitted or reimbursed by an employer or paid with a business or corporate check.
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- Can I pay my premium electronically or through automatic withdrawal?
Yes, Group Conversion and Nongroup members can enroll to have their premiums automatically deducted form their personal or checking accounts after the first premium billing is paid. To enroll, complete the Automatic Payment Enrollment form and mail it per the mailing instructions on the form. You can also fax it to us at (989) 790-6518.
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- Can I pay more or less than the amount on the billing statement?
It is recommended that you pay only for the period and the amount shown on your billing statement to avoid any potential servicing issues.
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- What happens if I’m late with my premium payment?
All group Conversion and Nongroup plans are “pre-paid” plans. If payment is not received by the end date of your current coverage period, you may experience limited access to your benefits. If payment is not submitted by the date indicated on your bill, your coverage will not be in effect and your doctor, hospital or pharmacy will be advised that your coverage is not active. If you have questions about your bill, please call a customer service representative.
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- If my coverage is cancelled for nonpayment, can I reapply?
Yes, but you cannot reapply unless the date of re-application is at least 12 months after the original plan coverage effective date.
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- On my next birthday, I will be eligible for the next band of age rating. When will my rates change?
The rates are quoted on the age of the subscriber at the time of enrollment. The rates will change as the subscriber’s age increases to a new age band. This rate change will occur on the first billing cycle after the subscriber’s date of birth, when the subscriber’s age exceeds the age in the current age band.
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- Using Your Health Plan Coverage how does the Individual Blue plan work?
Individual Blue is a Preferred Provider Organization (PPO) plan. PPO plans are designed to provide you with the highest level of benefits and the lowest out-of-pocket costs when you receive care from providers who are part of our PPO network.
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- Do I still have coverage if I go outside the PPO network?
Yes, but you share more of the cost of your care through higher copays. You may also be responsible for any differences between what the provider charges and our approved amount for the service.
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- How can I find a PPO provider?
You can search for providers on the BCBSM website (BCBSM.com). If you have difficulty locating a PPO provider, please call customer service at 1-800-869-BLUE.
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- Am I covered In-Network if I travel out-of-state?
When you’re a Blue Cross Blue Shield member, you take your health care benefits with you- across the country and around the world. Simply call the BlueCard program at 1-800-810-BLUE (2583) for the names of the nearest network doctors and hospitals.
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Click here if you prefer F.A.Q. about individual medical plans in a PDF file.
Note: This publication is intended to provide accurate and authoritative information on the subject matter covered. It is distributed with the understanding that neither the publisher nor the distributor are rendering legal, accounting, or other professional advice and assume no liability whatsoever in connection with its use.
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