Benefit Plans - Human Resources

NMU’s PPO Plan through Blue Cross Blue Shield of Michigan (BCBSM) uses a network of physicians, hospitals, and other health care specialists who have signed agreements with us to accept the approved amount as payment in full for covered services.  When you use PPO network providers, your out-of-pocket costs for covered services are limited to the co-pays and deductibles stated in the summary of benefits. Here’s what you need to do when you need medical care:

• Choose a provider from the BCBS Provider Directory.
• Make your appointment directly with that provider.  You can also ask your provider if they are in the PPO Network.

You do not have to choose just one provider for your care and you do not have to notify us if you decide to change physicians.  Just remember to select your provider from the directory and you will stay in-network.  If you would like to verify if a provider is in the BCBS network, please review the Provider Directory or contact BCBS's customer service line at 800-879-1945.

To receive benefits at the in-network level, your care must be received from a Community Blue PPO provider.  You do not need to use Community Blue PPO network provider for the following services, you must, however, follow coverage requirements.

• Services where there is no network available.
• Services covered under a separate dental, or vision plan.

Special Note for Parents of Students:  If you have dependents attending school, but living away from home, you should help them choose a Community Blue Preferred PPO physician near their school.  Please refer to the nation-wide provider directory.

Non-Network Providers

When you receive care from a provider who is not part of the Community Blue PPO network, without a referral from a PPO provider, your care is considered out-of-network.

Before choosing a non-network provider, you should verify if the service would be covered.  Some services, such as your preventative care services, are not covered out-of-network.

If you choose to receive services from a non-network provider, you can still limit your out-of-pocket costs if the provider participated in traditional BCBS plans.

If you use BCBS participating providers outside the PPO network:

• The provider will bill BCBS directly for your services.
• You will not be billed for any differences between BCBS’s approved amount and the provider charges.

How do I appeal a health plan decision?

BCBS Information 

• 24 Hour Nurse Line
• Summary of Benefits Coverage * Effective 1/1/2025
  • All group and individual health plans must provide a uniform summary of benefits and coverage (SBC) to applicants and enrollees. The Affordable Care Act (ACA) requires insurers and health plans to provide consumers with standardized and easy-to-read information about the plan using a common form that is intended to make it easier for consumers to compare plans. The SBC must describe the main features of the plan, including covered benefits along with any limitations or exclusions, cost sharing requirements, and whether it meets minimum essential coverage and value standards. The SBC must also include examples of how the policy or plan would cover care for certain health conditions or scenarios, showing hypothetical costs for consumers and how much the plan would pay.  Finally, the SBC includes uniform definitions of common insurance-related terms. 
• A Guide to Reading your EOB
• Your Benefits Guide
• BCBS Coordinated Care Core Program - Care Management Program

1. Go Paperless using your Blue Cross Member Account
2. BCBS Global Core - Coverage Abroad
   • Global Core International Claim Form
3. A Guide to Reading your EOB
4. How do I appeal a health plan decision?
5. Blues 365
6. How to Register at www.bcbsm.com
7. BCBSM.com site FAQ's
8. Experian Identity Works ID Protection
9. Experian Identity Works Fact Sheet
10. Uniform Glossary of Health Coverage and Medical Terms

CVS/Caremark Prescription Coverage Information

• CVS Caremark Benefits-At-A-Glance
• Participant Overview
• Sample ID Card

Diabetic Benefits

A nonopioid directive helps fight the opioid epidemic by allowing patients to notify health professionals they do not want opioids.  A patient, a person’s legal guardian, or patient advocate can now fill out a State of Michigan Form that directs health professionals and emergency medical services personnel to not administer opioids.  The form should be submitted to the patient's primary care physician and included in the patient’s medical records.

A link to the directive form can be found by visiting www.michigan.gov/opioids.  Click on the “Find Help” section and then scroll down to the bottom to "Additional Resources."

The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, allows you to continue group medical insurance, prescription drug, dental and vision coverage on an individual basis when you or your dependents become ineligible for University benefits.  At that time, the COBRA notice and current rates will be mailed to your, or your dependents losing the health benefits.

Dental coverage is provided through Blue Cross Blue Shield of Michigan (BCBSM)

Vision coverage is provided through EyeMed Vision

Coverage for both:

• is effective the date of hire.
• must be applied for within the first 30 days of hire.
• may be changed if the Human Resources Department (227-2470) is notified within 30 days of a status change.
• may be applied for or changed during the annual Open Enrollment period in December.
• coverage will continue for dependent children, if enrolled, to the end of the month in which he/she turns age 26.

Bi-weekly deductions, if any,

• are based on 26 pay periods,
• are dependent on the employee group, and the number of family members covered,
• are subject to change.

Your ID cards will be mailed to your home address usually within a week of enrollment.   

• HRA and FSA Qualified Expenses
• FSA Summary Plan Description (SPD)
  • Summary of Material Modifications #1
  • Summary of Material Modifications #2
  • Summary of Material Modifications #3
• Healthcare Flexible Spending Account
• Dependent Care Flexible Spending Account
• FSA Store
• Change of Status/Termination Election Form
• Video - Is an FSA Right for Me?

Please visit healthequity.com/wageworks to learn more about the plan and, if enrolled, access your account information.

If you have questions, please utilize the Live Chat function within your participant portal at www.healthequity.com/wageworks or call the HealthEquity team at 866-242-3458.  They are available 24/7.

Employees may purchase term life insurance for their spouses and/or dependent children (through age 26).  Four benefit levels of supplemental dependent life insurance exist, as specified below.

Supplemental life coverage (employee and dependent) may be elected within 30 days of hire or qualifying change of status.  Additional enrollment options are available during annual enrollment in November of each year.  

Additional life insurance may be purchased and paid through payroll deduction. Additional coverage is available in multiples of your salary from 1/2 up to 5x your salary, subject to a maximum of $1,000,000, with a guaranteed issue amount of $500,000.  Rates are based on your age and are shown below.

Please use this Supplemental Life Calculations spreadsheet to calculate the values available, based on your salary, and their associated bi-weekly premium based on your 5-year age band: 

EXAMPLE: A 42 year old employee with an annual salary of $47,900 elects 3 times their annual base salary in supplemental life insurance.

$47,900 x 3 = $143,700 rounded to the nearest thousand would provide $144,000 in supplemental life insurance.

$.0674 (rate for age range) x 144 (amount of coverage in thousands) = $9.71/bi-weekly

• Reporting and Procedures