Medical Insurance

Medical Plan Information

Health Care Provider Links

Benefits Provider Directory

Blue Cross and Blue Shield of Michigan

DMC CARE (PPO)
* Physician Search
* Providers being eliminated from the DMC Care Network in 2008

Community Blue (PPO)

Blue Care Network (HMO)

Health Alliance Plan (HMO)

Total Health Care (HMO)

Pharmacare

Weyco

Travelling Outside of the United States?

The LewerMark Outbound Domestic Students, Staff, & Faculty Medical Benefits Plan is designed for outbound students, staff, faculty and their dependents.

The university offers a number of medical coverage options:

one traditional "fee-for service" plan: Blue Cross and Blue Shield of Michigan

This option may interest you if you want complete flexibility in choosing physicians. Blue Cross Blue Shield Traditional (BCBS) covers inpatient hospitalization, surgical fees, emergency care, and many outpatient procedures including diagnostic (non-preventive, non-routine) office visits, and prescription drugs. Appropriate deductibles and copays apply. There is no coverage for routine office visits, immunizations, or screening tests such as pap smears, mammograms, or prostate cancer screenings. In other words, Blue Cross Blue Shield does not cover any wellness or preventive care.

three health maintenance organizations (HMOs)
- Health Alliance Plan
- Blue Care Network
- Total Health Care

HMOs offer higher benefits and broader coverage including preventive care, office visits and prescription drugs. There is a lower overall out-of-pocket cost, and you pay no deductible with benefits generally paid at 100%. There is a $10 copay for each office visit.

If you elect an HMO, you must choose a primary care physician to manage all of your medical care. Out-of-Network care is not covered except in emergencies or with a written referral from your primary care physician and approval from the HMO. This is a major consideration if you live outside the HMO area. Each HMO has its own provider directory listing doctors, hospitals and other facilities in the network. Contact the HMO directly by phone or by going to their web site to review a current provider directory.

two preferred provider organizations (PPOs)
- DMC Care
- Community Blue

A PPO plan is a good choice for employees who want: more freedom to make choices in their health care; the ability to see a specialist without obtaining a referral from their doctor; a larger provider network (i.e., more doctors to choose from); and to be covered for services both in- and out-of-network.

The options differ in the benefit levels they provide, the doctors and hospitals you can use, and the cost.

Effective Date
Your effective date will be the first of the month following your date of hire if your application is received by Total Compensation and Wellness within 30 days of your date of hire.

Pre-Tax
Our medical and dental programs are governed by Section 125 of the Internal Revenue Code and provides a tax savings to you by reducing employee medical premiums from your gross salary prior to calculation of federal income and social security taxes, as allowed under Internal Revenue Code (IRC) Section 125.

You may begin, stop or change your medical coverage as defined by Section 125 of the Internal Revenue Code. Click the following link for the list of qualified family status changes: Changes Permitted Under Section 125 of the IRC

Medical premiums will automatically be taken as pre-tax, unless a Section 125 Waiver form is submitted to the Total Compensation and Wellness department.

Newly eligible employees may elect to waive Section 125 at the time they choose a medical plan. Otherwise it can only be changed during the open enrollment, for a January 1 effective date.

The Section 125 Plan reduction does not reduce the salary on which your maximum deferral limit for the Voluntary Investment Program is calculated.

The reduction does, however, lower the salary on which both Social Security and Unemployment Benefits are calculated. If you are close to beginning a Social Security benefit you may wish to consider waiving the Section 125 Plan for your medical premiums.

This is your annual opportunity to review your health care coverage and decide if you want to stay with what you have or change to another plan. During this period, you can enroll (if not currently covered by a university sponsored plan), add eligible dependents not currently covered, or simply correct inaccurate information.

Eligibility

Employees: In general, you are eligible for medical insurance provided by the university if:

You are a regular staff member and your appointment is 50% time or more.
You are a retiree or you are receiving long-term disability benefits.

Employees represented by the Building Trades, part-time faculty, technicians and students are not eligible for medical benefits. Employees represented by H.E.R.E. (McGregor unit) should contact the Business Office of McGregor for a description of their medical benefits.
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Dependents: You can enroll your dependents in the medical insurance. Eligible dependents include your:

Legal spouse or same sex domestic partner. (Coverage for domestic partners is only available to non-represented employees and employees represented by the AAUP and UAW locals 1979 and 2071.)
Your unmarried children or the unmarried children of your spouse who are:
- Children by birth or adoption until the end of the calendar year in which they reach the age of 25.
  - Children from birth to age 19 can be covered regardless of where they live.
  - Children between the ages of 19 and 25 must continue to live primarily with you and be claimed as your dependents on your income tax return.
- Children by legal guardianship until the end of the year in which they reach the age 19.
- Children of your spouse who live with you and are claimed as dependents on your joint tax return until the end of the year in which they reach age 25. (Coverage through Wayne State University for children of your spouse will be secondary to coverage provided by both natural parents.)
- Principally supported children (not your children by birth or marriage) through the end of the year in which they reach age 19 who are:
  - principally supported by you for at least six consecutive months,
  - related to you by blood or marriage, and
  - claimed as your dependents on your most recent income tax return.
- Unmarried disabled dependent children who:
  - have reached the end of the year in which they turned 25,
  - are dependent on you for support and maintenance,
  - became disabled before reaching age 19, and
  - are incapable of self-sustaining employment by reason of mental or physical handicap.
- Your sponsored dependent, defined as:
  - an adult, age 26 or older
  - dependent on your support,
  - claimed on your most recent tax-return, and
  - who resides with you permanently.
- Your senior rider, defined as:
  - an adult, age 65 or older,
  - dependent on your support,
  - claimed on your most recent tax-return,
  - who resides with you permanently, and
  - is eligible for Medicare.
    
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Retroactive Coverage

You may not request retroactive coverage to your eligibility date once the deadline for submission has passed.
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No Coverage Option

You may decide that you do not want medical coverage through the University. Before choosing this option, be sure of your choice. If you decide not to sign up for or to cancel your coverage, you cannot enroll in a University plan until the next annual open enrollment, or if you wish to have HAP or BCBS, the first of the month following ninety days from the date your request is received by Total Compensation and Wellness.
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Cash in-Lieu of Medical Insurance (more)

If you wish to elect the cash in-lieu of medical insurance option, you must complete the waiver form in the back of this brochure and return it with proof that you are covered through another employer group plan. An ID card is not sufficient proof of coverage.

You will not receive the cash benefit if your other coverage is Medicare A&B, COBRA, Medicaid, an individual plan or your parent’s coverage. The cash benefit will not be retroactive.

Election Form for Cash in Lieu Medical Benefit

Human Resources

Medical Insurance