BLUE CROSS BLUE SHIELD OF MICHIGAN

Michigan Health Insurance .biz recommends the Individual Care Blue plan which has
NO DEDUCTIBLE and NO UNDERWRITING!
Click Here To Apply Now!

Individual Care Blue Monthly rates for Individuals/Families (Rates are effective October 1, 2006, and are subject to change with 30-day notice)
	Age
	<25	25-29	30-34	35-39	40-44	45-49	50-54	55+
One Person	$141.15	$176.46	$190.73	$210.84	$239.66	$282.71	$345.93	$504.20
Two Person	$282.30	$352.92	$381.45	$421.68	$479.31	$565.41	$691.89	$1008.42
Family	$296.44	$370.58	$400.55	$442.76	$503.28	$593.67	$726.48	$1058.85
Dependents, 19 & Older*	$108.61	$108.61	$108.61	$108.61	$108.61	$108.61	$108.61	$108.61

Monthly Rates for Individuals/Families transferring from a Blue Cross Blue Shield employer-sponsored health plan (Rates are effective October 1, 2006, and are subject to change with 30-day notice)
	Age
	<25	25-29	30-34	35-39	40-44	45-49	50-54	55+
One Person	$129.62	$162.52	$176.30	$195.71	$223.02	$263.67	$322.96	$470.19
Two Person	$259.22	$325.04	$352.61	$391.43	$446.05	$527.34	$645.91	$940.37
Family	$272.20	$341.31	$370.26	$411.00	$468.35	$553.72	$678.22	$987.40
Dependents, 19 & Older*	$100.62	$100.62	$100.62	$100.62	$96.96	$96.96	$96.96	$96.96

*Must meet eligibility criteria

How Do I Enroll In Individual Care Blue & Value Blue?
Print out and complete an application and email to multiquote@mqins.com or fax to 319-208-7791. You may also mail to our processing office at:

MultiQuote Insurance Agency
Attn: Michigan Health Insurance
1237 Ave H
Fort Madison, IA 52627

Individual Care Blue & Value Blue Plan
Benefits-at-a-Glance

	Individual Care Blue PPO	Value Blue PPO & Traditional
Deductible	None	$1,000 Individual - $2,000 Per Family
CoPay	30% For General Services	30%
Out Of Pocket Maximum (Excludes Prescription)	$2,500 Per Family	$2,500 Per Family
Inpatient Care In Participating Hospitals
120 general care days in a semi-private room with general nursing & physician care, per benefit period.	Covered 70%	Covered 70% after deductible
Emergency Room Care
Life-threatening medical emergencies	Covered 70%	Covered 70% after deductible
Mental Health Care & Substance Abuse Treatment In Participating Hospitals & Residential Substance Abuse Facilities
Inpatient Facility Charges	Covered 70% up to 30 days; 60 day renewal	Covered 70% after deductible up to 30 days; 60 day renewal
Outpatient Substance Abuse	Covered 70% up to state mandated dollar amount	Covered 70% after deductible up to state mandated dollar amount
Medical & Surgical Care
Surgery	Covered 70%	Covered 70% after deductible
Maternity - Delivery & Newborn Exam Only	Covered 70%	Covered 70% after deductible
Physical Therapy	Covered 70% 60 consecutive, renewable days per condition	Covered 70% after deductible 60 consecutive, renewable days per condition
Lab & Pathology, EKG's, X-Ray's	Covered 70%	Covered 70% after deductible
Mammography Screening	Covered 70%	Covered 70% after deductible
Prosthetic Appliances	Covered 70%	Covered 70% after deductible
Office Visits	2 visits per year	Not Covered
Preventive Care Services	In-network services are covered up to a combined maximum of $500 per member per year. Services include maintenance exam, sigmoidoscopy, gynecological exams, routine pap smears, fecal occult blood screening, prostate specific antigen screening, routine laboratory & radiology services, well baby care & immunizations.	Not Covered
Hospice Care
Two 90 day periods, & one 30 day period	Covered 100% up to lifetime dollar maximum	Covered 100% up to lifetime dollar maximum
Human Organ Transplants
Liver, Heart, Pancreas, Lung, & Heart-Lung	Covered up to $1,000,000 lifetime maximum for each	Covered up to $1,000,000 lifetime maximum for each
Bone Marrow, Cornea, Kidney, & Skin	Covered 70%	Covered 70% after deductible
Prescription Drugs
Prescription Drugs	Covered 50% with $10 minimum/$100 maximum; covered up to $2,500 per member per year	Not Covered; discounts available through Affinity Rx Program

PPO benefits noted are for care provided by contracted providers. This is intended as an easy to read summary. This is not a contract. Additional limitations and exclusions may apply to covered services.

What If I Have Pre-Existing Health Conditions?
With Blue Cross Blue Shield of Michigan you will not be declined due to health problems and will not receive exclusion riders or rate-ups. There is however a 180 day waiting period on pre-existing conditions meaning for the first 180 days your policy is in force any pre-existing health conditions will not be covered, after the 180 days are met these conditions will be covered.

The 180 day waiting period on pre-existing conditions may be waived if you meet the qualifying criteria which are:

At least 18 months of previous health insurance coverage through an employer without a lapse of more than 62 days.
No longer eligible for COBRA.
No longer eligible for coverage through an employer.

How Soon Can My Coverage Start?
The effective date will be the first pay period following 2 weeks from the date your application is received. The pay periods are the 1st, 10th, and 20th of each month.

How Do I Enroll In Individual Care Blue?
Print out and complete an application and email to multiquote@mqins.com or fax to 319-208-7791. You may also mail to our office at:

MultiQuote Insurance Agency
Attn: Michigan Health Insurance
1237 Ave H
Fort Madison, IA 52627

Or call 1-800-593-2235 for assistance.

Blue Cross Blue Shield of Michigan will process your application and send you a bill. Once your payment is received your coverage is in effect and your ID card will be mailed to you. This process normally takes about 2 weeks. Going forward, you will be billed every 2 months.

If you are transferring from a Blue Cross Blue Shield of Michigan employer-sponsored health plan, your coverage will be effective back to your termination date if you've applied within 60 days.

If you are not transferring from a Blue Cross Blue Shield of Michigan employer-sponsored health plan, you may request a coverage start date on your application or Blue Cross Blue Shield of Michigan will assign one to you. Assigned coverage start dates are typically 2 weeks of the date your application is received.

Click Here To Print An Application!

Am I Eligible For Individual Care Blue?
To Receive Coverage:

You must be a Michigan resident and live in the state for a minimum of 6 months each year.
You must not be eligible for coverage provided to you by your employer or spouses employer.
You can not currently be covered by another health plan, including Medicare.
Your employer is not contributing towards your bill or reimbursing you for any portion of your bill.

I Recently Had Blue Cross Blue Shield of Michigan Coverage Through My Employer. Can I Enroll In Individual Care Blue?
To Receive Coverage You Must Meet The Previous Criteria and:

You must have Blue Cross Blue Shield of Michigan employer sponsored coverage for at least 3 months prior to enrolling in Individual Care Blue.
You can not have coverage through another carrier between your former plan and Individual Care Blue.
You must apply within 60 days of the termination of your former employer-sponsored coverage.
You prior coverage can not have been terminated because of non-payment or fraud.

This is intended as an easy-to-read summary. It is not a contract. Additional limitations and exclusions may apply to covered services. For an official description of benefits, please see the applicable Blue
Cross Blue Shield of Michigan certificate and riders. Payment amounts are based on the Blue Cross Blue Shield of Michigan approved amount, less any applicable deductible and/or copay amounts
required by the plan. This coverage is provided pursuant to a contract entered into in the state of Michigan and shall be construed under the jurisdiction and according to the laws of the state of Michigan.
Michigan’s most trusted name in health care.

BLUE CROSS BLUE SHIELD OF MICHIGAN
Michigan's most trusted name in health insurance.

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