Member Benefits

Understanding Your Core Benefits

We want to help you get, stay and be healthy. That means health care benefits that give you the care you need, when you need it. Blue Cross Complete of Michigan members have a wide range of benefits, including:

  • Preventive and routine health care such as doctor visits, vaccines and more
  • Medical supplies, like diabetes test strips
  • Urgent and emergency care
  • Medicines
  • Transportation to and from covered medical services

Information about benefit requirements can be found in your Blue Cross Complete Member Handbook (PDF) and Certificate of Coverage (PDF). A list of programs and services available to you can be found in the Benefits Snapshot (PDF). For additional questions, call Customer Service at 1-800-228-8554. TTY users, call 1-888-987-5832.

Some services require your doctor to submit a request to Blue Cross Complete to treat your condition. This is known as an authorization. The Prior Authorization Requirements Form (PDF) explains which services require an authorization.

As a Blue Cross Complete member, you’re not required to pay for medically necessary, covered services from Blue Cross Complete network providers.

If you get a bill or statement, call Customer Service at 1-800-228-8554, 24 hours a day, seven days a week. TTY users, call 1-888-987-5832.

You may have to pay when:

  • A service is provided by a provider who isn’t in the Blue Cross Complete network and prior authorization wasn’t given to see this provider (except for emergency services).
  • The service provided isn’t covered by Blue Cross Complete. Your provider told you that it’s not covered and you signed a written agreement to pay for the service before you received it.

If you're currently receiving services from a provider prior to enrolling with Blue Cross Complete, we can help you with a smooth transition. You may be able to continue getting these services at the time of enrollment for 90 days. This may also include certain prescriptions without prior authorizations. You can request continuity of care by calling the Rapid Response Outreach Team at 1-888-288-1722 or your care manager. TTY users, call 1-888-987-5832.

You must have a relationship with a specialist, primary care provider, or other covered provider prior to enrolling with Blue Cross Complete to establish continuity of care. When requesting continuity of care, we'll need to know:

  • The name of your provider
  • Contact person
  • Phone number
  • Service type and appointment date
For more information, view the Transition of care requirements (PDF).

Blue Cross Complete’s care coordination program connects services for new and existing members with short-term or emerging needs. Our care connectors help to:

  • Address pharmacy questions
  • Secure durable medical equipment
  • Plan for discharge
  • Find dentists and doctors

Care managers perform assessments and address needs through an individualized action plan. Our care managers, care connectors and community health navigators aim to help teach members that you have control over your health and well-being.

While Blue Cross Complete doesn't require referrals, we recommend you talk with your primary care doctor to coordinate care. We can help you find a doctor.

If you need help coordinating your care, call Customer Service at 1-800-228-8554 (TTY: 1-888-987-5832). You can also talk with your doctor about care management services.

Overview of your benefits

The following provides an overview of your benefits.

Preventive and medical care

We cover the following preventive and routine medical care:

  • Doctor and specialist visits (chiropractors, podiatrists and nurse practitioners)
  • Regular or annual well visits
  • Vaccines except those for travel such as Cholera, scarlet fever and typhoid
  • Lab work, x-rays and other imaging services
  • Allergy testing, treatment and injections
  • Family planning, including birth control (men and women)
  • HIV testing and treatment of sexually transmitted diseases
  • Services you may get at Federally Qualified Health Centers
  • Health education programs, including disease management and tobacco cessation
  • Medically necessary weight reduction services
  • Emergency and urgent care services
  • Rehabilitative therapy, including cardiac rehab, physical, speech and occupational therapies

Hospital and surgical care

When you need extra care or have an emergency, we cover:

  • Outpatient surgical services (this is when you don’t stay overnight at a hospital)
  • Chemotherapy and other drug treatments for cancer
  • Dialysis and treatment of kidney disease, including end-stage renal disease
  • Cost of a shared hospital room
  • Lab work, x-rays, imaging services, therapies and other medical supplies while you’re in the hospital

Home health care, skilled nursing services and hospice care

Sometimes, you may need long-term care. To help you get the care you need, we may cover:

  • Short-term skilled nursing home services (long-term care is provided by the state of Michigan)
  • Home health care services for members who are homebound
  • Supplies and equipment related to home health care
  • Hospice care
    • Special note: Hospice care must be approved by us. Care must take place in our service area.

Durable medical equipment

Some medical conditions need special equipment. We cover:

  • Equipment such as nebulizers, catheters, crutches, manual wheelchairs and other devices
  • Disposable medical supplies, such as ostomy supplies, peak flow meters and alcohol pads
  • Diabetes supplies, such as lancets, test strips, insulin needles, blood glucose meters and insulin pumps
  • Prosthetics and orthotics
    • Special note: Prosthetics replace a missing body part. They may also help the body function. Orthotics correct, align or support body parts that may be deformed.

To get durable medical equipment, you need a prescription from your doctor. You may also need authorization from us. You must get your item from a network provider. To find network durable medical equipment providers, call Customer Service at 1-800-228-8554. TTY users should call 1-888-987-5832.

Vision

Eye care is an important part of your overall health. To make sure your eyes are healthy and help you see the best you can, we cover:

  • Routine eye exams once every two years
  • Nonroutine eye exams for evaluating chronic, acute or sudden abnormal ocular conditions
  • One pair of glasses every two years
  • Replacement glasses if your glasses are lost, stolen or broken beyond repair and the number of replacements has not exceeded Medicaid limits:
    • For beneficiaries age 21 and over, one pair of replacement glasses per year
    • For beneficiaries under age 21, two pair of replacement glasses per year

                 Note: One year is defined as 365 days from the date the first pair of glasses (initial or
                 subsequent) was ordered

  • Glaucoma screenings every year
  • Retinal eye exams for members with diabetes. No referral is needed

The services must be from a network vision center. For a list of network eye doctors and vision centers, call Customer Service at 1-800-228-8554. TTY users should call 1-888-987-5832.

Hearing

How well you hear affects your quality of life. We offer hearing benefits for members of all ages. Here’s what we cover:

  • Hearing aid exams to evaluate what type or brand of hearing aid you need
  • One hearing aid unit (or one per ear if medically necessary). This includes earphone (receiver or oscillator), ear mold, necessary cords, tubing and connections. The hearing aid unit must be a conventional amplification device. It must also be an in-the-ear, behind-the-ear or on-the-body type and identified as basic to your hearing requirements
  • Hearing aid fitting, which includes one follow-up visit to evaluate its performance and to determine its conformance to prescription
  • Batteries, maintenance and repair for hearing aids

Hearing exams and hearing aid evaluations are available from a network provider. Go to Find a Doctor, then search for “hearing aid.” If you have questions about this benefit, contact Customer Service at 1-800-228-8554. TTY users should call 1-888-987-5832.

Mental health services

We want you to have the best mental health. To help you, we cover medically necessary outpatient mental health services. This applies to members with mild to moderate mental health needs. If you have chronic mental health needs, you will get these services through the Prepaid Inpatient Health Plan operating in your county.

Michigan Behavioral Health Standard Consent Form
Sharing behavioral health information helps your doctors coordinate your care. It also helps make sure your treatments and medicines are safe and all your health needs have been addressed. You can give your doctor permission to share your behavioral health records with other providers. Fill out the Michigan Behavioral Health Standard Consent Form at michigan.gov/bhconsent and take it to your health care provider. Make sure you keep a copy. 

Customer Service can help you find a network mental health provider in your area. Call 1-800-228-8554. TTY users should call 1-888-987-5832.

If you need emergency care for a life-threatening condition, or if you’re having thoughts of suicide or death, go to the nearest emergency room or call 911.

Care for women

Women have special health needs. To help you get the care you need, we cover:

  • Family planning. You don't need a referral
  • Pregnancy testing
  • Birth control and birth control counseling
  • HIV testing and treatment of sexually transmitted diseases
  • Pregnancy and maternity care
  • Prenatal and postpartum care
  • Midwife services in a health care setting
  • Delivery care
  • Mammograms and breast cancer services
  • Pap tests

Care for children and teens

The health care children and teens get shapes their adult health habits. To help someone younger than age 21 to be as healthy as he or she can be, we also cover:

  • Regular well visits and follow-up care
  • Physical exams and developmental screening
  • Childhood vaccines
  • Testing for lead exposure
  • Services you may get at Child and Adolescent Health Centers
  • Early Periodic Screening Diagnosis and Treatment program services
  • Hearing exams and hearing aids
  • Eye exams and glasses
  • Oral health screening and fluoride treatment

Transportation

We understand there may be times when you need a ride to your doctor’s office, to pick up a prescription or for other covered medical services. We can help you get there.

For more information about transportation or to schedule a ride, visit our transportation page.

Pharmacy

Blue Cross Complete members are eligible for pharmacy benefits. Pharmacy benefits can be used to fill select prescription and over-the-counter medicines at a participating network pharmacy. Visit the pharmacy page for an in-depth look at your pharmacy benefits.

Community Resources

Visit our Community Resources page to learn more about community resources, discounts, health information, programs and services to help you live a healthier life.

Additional services

24-hour Nurse Help Line
Our free 24-hour Nurse Help Line can help you get answers to your health questions right away. It's a confidential service just for you. The nurse line can help you make informed health care choices when your doctor is not available. Our 24-hour Nurse Help Line can be reached at 1-888-288-1724. TTY users should call 1-888-987-5832.

Advance Directives
Advance Directives are documents that state how you want medical decisions made if you lose the ability to make them for yourself.

Emergency Care Expenses Claim Reimbursement
Use the Emergency Care Expenses Claim Reimbursement form (PDF) to get reimbursed for out-of-pocket medical expenses from an emergency visit outside of our service area.

For a full list of your benefits, see the Blue Cross Complete Member Handbook (PDF).

For a full list of Healthy Michigan Plan benefits, visit the Healthy Michigan Plan page.