BCBSM

5/24/22, 2:48 PM Shopping | BCBSM
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ej SHOPPING FOR 48309 - Oakland County Myself + 2 Dependents $10,000.00
EFFECTIVE DATE Jun 24, 2022 QUALIFYING LIFE EVENT Other - June 23, 2022
Your 2022 On Marketplace Plan Options

These plans match the information you provided.
23 Results Name Price

Medical (/enroll/ccrz__ProductList?categoryId=a481Q000000WpOAQA0&cartId=5885ad77-50b3-4c1f-abc8-
b91f3a66df3c&cclcl='en_US) 
On Marketplace (/enroll/ccrz__ProductList?categoryId=a481Q000000Wpn5QAC&cartId=5885ad77-50b3-4c1f-abc8-
b91f3a66df3c&cclcl='en_US)
Off Marketplace (/enroll/ccrz__ProductList?categoryId=a481Q000000WpnAQAS&cartId=5885ad77-50b3-4c1f-abc8-

https://bcbsm.force.com/enroll/ccrz__ProductList?categoryId=a481Q000000Wpn5QAC&cartId=5885ad77-50b3-4c1f-abc8-b91f3a66df3c&cclcl=%27en_US 1/37

Dental (/enroll/ccrz__ProductList?categoryId=a481Q000000WpOFQA0&cartId=5885ad77-50b3-4c1f-abc8-

Vision (/enroll/ccrz__ProductList?categoryId=a481Q000000WpOKQA0&cartId=5885ad77-50b3-4c1f-abc8-

Dental + Vision (/enroll/ccrz__ProductList?categoryId=a481Q000000WpOPQA0&cartId=5885ad77-50b3-4c1f-abc8-
FILTER BY
Plan Type 
Metro Detroit HMO
Preferred HMO
Premier PPO
Select HMO
Metal Tier 
Bronze
Gold
Silver
Network Type 
HMO
PPO
HSA Eligible 
Eligible
Not Eligible
Blue Cross® Metro Detroit HMO Bronze

(/enroll/ccrz__ProductDetails?
sku=2022_98185MI044000501&cartId=5885ad77-50b3-4c1f-abc8-

HMO Medical
BCN®

Bronze

Marketplace Eligible
$8,700
Individual Deductible
$17,400
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
0%
Coinsurance
+ Compare
$639.02
per month
Select
Blue Cross® Metro Detroit HMO Bronze Saver HSA


HMO Medical
BCN®

Bronze

HSA Eligible

$7,000
$14,000
Family Deductible
$7,000
Max Individual
Out-of-Pocket
$14,000
Max Family
Out-of-Pocket
$0
PCP Co-pay
0%
Coinsurance
+ Compare
$669.86
per month
Select
Blue Cross® Select HMO Bronze (/enroll/ccrz__ProductDetails?


HMO Medical
BCN®

Bronze

$8,700
$17,400
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
0%
Coinsurance
+ Compare
$684.63
per month
Select
Blue Cross® Select HMO Bronze Saver HSA


HMO Medical
BCN®

Bronze

HSA Eligible

$7,000
$14,000
Family Deductible
$7,000
Max Individual
Out-of-Pocket
$14,000
Max Family
Out-of-Pocket
$0
PCP Co-pay
0%
Coinsurance
+ Compare
$717.68
per month
Select
Blue Cross® Preferred HMO Bronze (/enroll/ccrz__ProductDetails?


HMO Medical
BCN®

Bronze

$8,700
$17,400
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
0%
Coinsurance
+ Compare
$749.51
per month
Select
Blue Cross® Preferred HMO Bronze Saver HSA


HMO Medical
BCN®

Bronze

HSA Eligible

$7,000
$14,000
Family Deductible
$7,000
Max Individual
Out-of-Pocket
$14,000
Max Family
Out-of-Pocket
$0
PCP Co-pay
0%
Coinsurance
+ Compare
$785.69
per month
Select
Blue Cross® Metro Detroit HMO Silver Saver


HMO Medical
BCN®

Silver

$4,000
$8,000
Family Deductible
$7,800
Max Individual
Out-of-Pocket
$15,600
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$914.59
per month
Select
Blue Cross® Premier PPO Bronze Saver


PPO Medical
BCBSM®

Bronze

$8,700
$17,400
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$0
PCP Co-pay
0%
Coinsurance
+ Compare
$962.03
per month
Select
Blue Cross® Select HMO Silver Saver (/enroll/ccrz__ProductDetails?


HMO Medical
BCN®

Silver

$4,000
$8,000
Family Deductible
$7,800
Max Individual
Out-of-Pocket
$15,600
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$979.89
per month
Select
Blue Cross® Metro Detroit HMO Silver


HMO Medical
BCN®

Silver

$3,200
$6,400
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$987.49
per month
Select
Blue Cross® Metro Detroit HMO Silver Extra


HMO Medical
BCN®

Silver

$5,300
$10,600
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,023.06
per month
Select
Blue Cross® Premier PPO Bronze HSA


PPO Medical
BCBSM®

Bronze

HSA Eligible

$7,000
$14,000
Family Deductible
$7,000
Max Individual
Out-of-Pocket
$14,000
Max Family
Out-of-Pocket
$0
PCP Co-pay
0%
Coinsurance
+ Compare
$1,045.08
per month
Select
Blue Cross® Select HMO Silver (/enroll/ccrz__ProductDetails?


HMO Medical
BCN®

Silver

$3,200
$6,400
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,058.06
per month
Select
Blue Cross® Preferred HMO Silver Saver


HMO Medical
BCN®

Silver

$4,000
$8,000
Family Deductible
$7,800
Max Individual
Out-of-Pocket
$15,600
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,072.80
per month
Select
Blue Cross® Premier PPO Bronze Extra


PPO Medical
BCBSM®

Bronze

$8,000
$16,000
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$40
PCP Co-pay
40%
Coinsurance
+ Compare
$1,082.88
per month
Select
Blue Cross® Select HMO Silver Extra (/enroll/ccrz__ProductDetails?


HMO Medical
BCN®

Silver

$5,300
$10,600
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,096.17
per month
Select
Blue Cross® Preferred HMO Silver (/enroll/ccrz__ProductDetails?


HMO Medical
BCN®

Silver

$3,200
$6,400
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,158.37
per month
Select
Blue Cross® Preferred HMO Silver Extra


HMO Medical
BCN®

Silver

$5,300
$10,600
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,200.05
per month
Select
Blue Cross® Preferred HMO Gold (/enroll/ccrz__ProductDetails?


HMO Medical
BCN®

Gold

$850
$1,700
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,266.05
per month
Select
Blue Cross® Premier PPO Silver Saver HSA


PPO Medical
BCBSM®

Silver

HSA Eligible

$3,500
$7,000
Family Deductible
$7,000
Max Individual
Out-of-Pocket
$14,000
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,365.86
per month
Select
Blue Cross® Premier PPO Silver (/enroll/ccrz__ProductDetails?


PPO Medical
BCBSM®

Silver

$2,500
$5,000
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,400.13
per month
Select
Blue Cross® Premier PPO Silver Extra (/enroll/ccrz__ProductDetails?


PPO Medical
BCBSM®

Silver

$4,800
$9,600
Family Deductible
$8,700
Max Individual
Out-of-Pocket
$17,400
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,525.75
per month
Select
Blue Cross® Premier PPO Gold (/enroll/ccrz__ProductDetails?


PPO Medical
BCBSM®

Gold

$750
$1,500
Family Deductible
$7,500
Max Individual
Out-of-Pocket
$15,000
Max Family
Out-of-Pocket
$30
PCP Co-pay
20%
Coinsurance
+ Compare
$1,770.10
per month
Select
Premiums
Premiums are charged for the subscriber, spouse and all adult children age 21 and older, and for the three oldest dependent children under age 21. Premiums for Blue Cross® Vision
for Adults are charged to the three oldest adults age 19 and older.
Networks
Your network of affiliated doctors and hospitals may be different based on the product you choose. Please visit https://www.bcbsm.com/index/find-a-doctor.html
(https://www.bcbsm.com/index/find-a-doctor.html) or click on Plan Details then Provider Directory within each plan for more information on our networks. The BCN HMO medical plans
are managed-care plans; your care will be coordinated by a primary care physician that you select upon enrollment.
HealthEquity® HSA Option
If you already have our HSA but pick a non-HSA plan, you can still use the money in your HSA account, but can't add money to that account once your new plan starts. There is no
charge per month for our HSA. If you'd like to learn more, visit bcbsm.com/hsa (http://bcbsm.com/hsa)
Pediatric Vision
Pediatric vision benefits are included in all medical plans. Pediatric vision covers all members under the age of 19 on their plan effective date.
Prescription Drug Coverage
To view the 2021 BCBSM and BCN prescription drug formularies, visit:
bcbsm.com/2021selectdruglist (https://www.bcbsm.com/content/dam/public/marketplace/2021-individual/documents/custom-select-drug-list.pdf).
To view the 2022 BCBSM and BCN prescription drug formularies, visit:
IBU PPO https://www.bcbsm.com/2022-select-five-tier (https://www.bcbsm.com/2022-select-five-tier)
IBU HMO https://www.bcbsm.com/2022-select-six-tier (https://www.bcbsm.com/2022-select-six-tier)
Child Only policies
Child-Only policies are available on all plans above. Child-Only policies are available to any child who will be under age 21 on the policy effective date.
Catastrophic Coverage
If you are 30 or over and would like to check your eligibility for a hardship exemption to enroll in a Catastrophic (Value) plan please contact a Health Plan Advisor at 1-888-899-3012 or
your Blues Agent.
Dental, Adult Vision, and Dental with Vision Plan Selection
To learn more about dental and vision plans, visit bcbsm.com/dental (http://bcbsm.com/dental). All dental plans include access to more than 280,000 dental locations.
Visit www.mibluedentist.com (http://www.mibluedentist.com) to find a dental provider. Dental plans with vision and Blue Cross® Vision for Adults use the VSP Choice network.
Visit vsp.com (http://www.vsp.com/) to find a vision provider.
Vision benefits are for adult members who are 19 years or older on their plan effective date. Pediatric vision benefits are included in all BCBSM/BCN medical plans. Members effective
as of January 1, 2019 who subsequently terminate their coverage will not be able to purchase another Vision product for three years. If you’re applying for Blue Dental coverage and
your comprehensive dental coverage from another carrier ended within the last 60 days, you may be eligible for a waiver of your Blue Dental benefit waiting period.
If you are visually impaired, please visit the Federal Marketplace.
ATTENTION: To ensure individuals with disabilities have an equal opportunity to access enrollment services for Qualified Health Plans,
if you have a disability (such as visual or hearing impairment) auxiliary aids and alternative formats are available free of charge by
contacting HealthCare.gov (https://www.healthcare.gov/) or calling 1-800-318-2596 to speak with HealthCare.gov
(https://www.healthcare.gov/).
Plan quality ratings and enrollee survey results are calculated by CMS using data provided by health plans in 2019. The ratings will be
displayed for health plans for the 2020 plan year. Learn more about these ratings.
bcbsm.com/agentcompensation: (https://bcbsm.com/agentcompensation)This will allow members to see information related to

agent commissions.
To include a non-opioid directive in your medical records, please fill out the form. (https://www.bcbsm.com/opioids/index/)Once
completed, send or email a copy to your primary care physician.
Attention: This website is operated by Blue Cross Blue Shield of Michigan and Blue Care Network and is not the Health Insurance
Marketplace® website at HealthCare.gov (https://www.healthcare.gov/). This website does not display all Qualified Health Plans
(QHPs) available through HealthCare.gov (https://www.healthcare.gov/). To see all available QHP options, go to the Health Insurance
Marketplace® website at HealthCare.gov (https://www.healthcare.gov/).
Also, you should visit the Health Insurance Marketplace® website at HealthCare.gov (https://www.healthcare.gov/) if:
1. You want to select a catastrophic health plan.
2. You want to enroll members of your household in separate QHP.
In offering this website, Blue Cross Blue Shield of Michigan is required to comply with all applicable federal laws, including the
standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and
security of personally identifiable information.
Blue Cross Blue Shield of Michigan and Blue Care Network offers the opportunity to enroll in either QHPs and off-Marketplace
coverage. Please visit HealthCare.gov (https://www.healthcare.gov/) for information on the benefits of enrolling in a QHP. Off-
Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.
View our Nondiscrimination Notice (https://www.bcbsm.com/index/common/important-information/policies-and-

practices/nondiscrimination-notice.html)
View our Privacy Policy (https://www.bcbsm.com/index/common/important-information/privacy-practices.html)
To see information in other languages, click here (https://www.bcbsm.com/index/common/important-information/policies-and-

practices/language-assistance.html)
© 1996-2020 Blue Cross Blue Shield of Michigan and Blue Care Network | Privacy Policy (https://www.bcbsm.com/index/common/important-information.html) | Licensing

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5/24/22, 2:48 PM Shopping | BCBSM

Plans for Individuals and Families Contact Us LOGIN

Get Started Choose Plans Review Enroll

Save this Quote

ej SHOPPING FOR 48309 - Oakland County Myself + 2 Dependents $10,000.00

Your 2022 On Marketplace Plan Options

23 Results Name Price

Off Marketplace (/enroll/ccrz__ProductList?categoryId=a481Q000000WpnAQAS&cartId=5885ad77-50b3-4c1f-abc8-

Metro Detroit HMO

Blue Cross® Metro Detroit HMO Bronze

Blue Cross® Metro Detroit HMO Bronze Saver HSA

Blue Cross® Select HMO Bronze (/enroll/ccrz__ProductDetails?

Blue Cross® Select HMO Bronze Saver HSA

Blue Cross® Preferred HMO Bronze (/enroll/ccrz__ProductDetails?

Blue Cross® Preferred HMO Bronze Saver HSA

Blue Cross® Metro Detroit HMO Silver Saver

Blue Cross® Premier PPO Bronze Saver

Blue Cross® Select HMO Silver Saver (/enroll/ccrz__ProductDetails?

Blue Cross® Metro Detroit HMO Silver

Blue Cross® Metro Detroit HMO Silver Extra

Blue Cross® Premier PPO Bronze HSA

Blue Cross® Select HMO Silver (/enroll/ccrz__ProductDetails?

Blue Cross® Preferred HMO Silver Saver

Blue Cross® Premier PPO Bronze Extra

Blue Cross® Select HMO Silver Extra (/enroll/ccrz__ProductDetails?

Blue Cross® Preferred HMO Silver (/enroll/ccrz__ProductDetails?

Blue Cross® Preferred HMO Silver Extra

Blue Cross® Preferred HMO Gold (/enroll/ccrz__ProductDetails?

Blue Cross® Premier PPO Silver Saver HSA

Blue Cross® Premier PPO Silver (/enroll/ccrz__ProductDetails?

Blue Cross® Premier PPO Silver Extra (/enroll/ccrz__ProductDetails?

Blue Cross® Premier PPO Gold (/enroll/ccrz__ProductDetails?

HealthEquity® HSA Option

Prescription Drug Coverage

IBU PPO https://www.bcbsm.com/2022-select-five-tier (https://www.bcbsm.com/2022-select-five-tier)

IBU HMO https://www.bcbsm.com/2022-select-six-tier (https://www.bcbsm.com/2022-select-six-tier)

Child Only policies

Dental, Adult Vision, and Dental with Vision Plan Selection

If you are visually impaired, please visit the Federal Marketplace.

bcbsm.com/agentcompensation: (https://bcbsm.com/agentcompensation)This will allow members to see information related to

2. You want to enroll members of your household in separate QHP.

View our Nondiscrimination Notice (https://www.bcbsm.com/index/common/important-information/policies-and-

View our Privacy Policy (https://www.bcbsm.com/index/common/important-information/privacy-practices.html)

To see information in other languages, click here (https://www.bcbsm.com/index/common/important-information/policies-and-

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