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Medical – Michigan 

Medical – Michigan 

Blue Cross Blue Shield Plan Options

​Choose from one of three medical plans to cover yourself and your dependents. All plans are through Blue Cross Blue Shield and include prescription coverage.

Employee Cost of Medical Coverage​
For all health plan options:  Employee contributions are reflected in the UKG platform, and based on your completion of the OswellThrives Wellness Program Initiatives / Tobacco Status / Spousal Surcharge.​

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RESOURCES

BCBMS $1000 PPO - SBC
BCBMS $3200 HSA - SBC
BCBMS $4000 HSA - SBC

Consumer-Driven High-Deductible Health Plans​

With the two HDHP / HSA plan options, you will:​

  • Have the option to select from a $3,000 Deductible and a $4,000 Deductible plan​
  • Enjoy lower per pay period medical plan costs​
  • Have preventive services covered at 100%​
  • Be eligible for a Health Savings Account through MMO’s partner bank (Wealthcare Saver) for ​tax-free deposits​
  • Receive Oswald Companies’ per pay contributions to your Health Savings Account​

PPO Plan​

With the traditional plan option, you will:​

  • $1,000 Deductible plan​
  • Experience a higher per pay cost for medical coverage as Oswald pays 78% of the premium, you pay 22% of the premium​
  • Enjoy the predictability of set copay amounts​
  • Have preventive services covered 100%​

PLAN #1

Blue Cross Blue Shield

$1,000 Preferred Provider Organization Plan (PPO)

Designed for those who prefer the predictability of set payments for doctor appointments and other medical services.
Medical Plan Provisions In-Network Out-of-Network
Deductible (embedded) $1,000 Individual / $2,000 Family $3,000 Individual / $6,000 Family
Maximum Out-of-Pocket (embedded) $8,150 Individual / $16,300 Family $16,300 Individual / $32,600 Family
Coinsurance 20% after Deductible 40% after Deductible
Primary Care Visits $30 Copay 40% after Deductible
Preventive Care Covered in Full 40% after Deductible
Specialist Visits $30 Copay 40% after Deductible
Emergency Room $150 Copay $150 Copay
Urgent Care $30 Copay 40% after Deductible
Rx Retail Copays
Generic $10 Copay $10 Copay +25%
Preferred Brand $40 Copay $40 Copay +25%
Non-Preferred Brand $80 Copay $80 Copay +25%
Specialty Drug $80 Copay $80 Copay +25%
Rx Mail Order
Generic $20 Copay Not Covered
Preferred Brand $80 Copay Not Covered
Non-Preferred Brand $160 Copay Not Covered
Specialty Drug $160 copay (30 day supply only) Not Covered

PLAN #2

Blue Cross Blue Shield

$3,200 High Deductible Health Plan (HDHP)

Designed for those who prefer to save premium dollars and to set money aside in a Health Savings Account (HSA) on a pre-tax basis. Medical and Pharmacy (Rx) claims would first apply to the plan deductible, then the plan cost sharing would apply. This plan has the lowest coinsurance amount In-Network, after the deductible is met.
Medical Plan Provisions In-Network
Deductible (embedded) $3,200 Individual / $6,000 Family
Maximum Out-of-Pocket (embedded) $6,900 Individual / $13,800 Family
Coinsurance 0% after Deductible
Primary Care Visits Covered in Full
Preventive Care 0% after Deductible
Specialist Visits 0% after Deductible
Emergency Room 0% after Deductible
Urgent Care 0% after Deductible
Rx Retail Copays
Generic $10 Copay
Preferred Brand $40 Copay
Non-Preferred Brand $80 Copay
Specialty Drug $80 Copay
Rx Mail Order
Generic $20 Copay
Preferred Brand $80 Copay
Non-Preferred Brand $160 Copay
Specialty Drug $160 copay (30 day supply only)

PLAN #3

Blue Cross Blue Shield

$4,000 High Deductible Health Plan (HDHP)

Designed for those who prefer to save premium dollars and to set money aside in a Health Savings Account (HSA) on a pre-tax basis. Medical and Pharmacy (Rx) claims would first apply to the plan deductible, then the plan cost sharing would apply. This plan has the lowest out of pocket maximum.
Medical Plan Provisions In-Network Out-of-Network
Deductible (embedded) $4,000 Individual / $8,000 Family $8,000 Individual / $16,000 Family
Maximum Out-of-Pocket (embedded) $6,350 Individual / $12,700 Family $12,700 Individual / $25,400 Family
Coinsurance 50% after Deductible 50% after Deductible
Primary Care Visits Covered in Full 50% after Deductible
Preventive Care 50% after Deductible 50% after Deductible
Specialist Visits 50% after Deductible 50% after Deductible
Emergency Room 50% after Deductible 50% after Deductible
Urgent Care 50% after Deductible 50% after Deductible
Rx Retail Copays
Generic 50% after Deductible 50% after Deductible + 20%
Preferred Brand 50% after Deductible 50% after Deductible + 20%
Non-Preferred Brand 50% after Deductible 50% after Deductible + 20%
Specialty Drug 50% after Deductible 50% after Deductible + 20%
Rx Mail Order
Generic 50% after Deductible Not Covered
Preferred Brand 50% after Deductible Not Covered
Non-Preferred Brand 50% after Deductible Not Covered
Specialty Drug 50% after Deductible Not Covered

All Pharmacy claims would apply to the Medical plan deductible, then the prescription copays would apply.