Overview of Benefits

    MESSA Super Care 1 2003 Revision is a traditional indemnity plan underwritten by Blue Cross Blue Shield of Michigan and BCS Life that provides comprehensive coverage and promotes quality standards of care.  Members can choose their doctors.  Members have no additional out-of-pocket costs beyond any applicable deductible or co-payment expense for covered services when visiting participating providers.  This is a brief description of benefits.  Please refer to the plan coverage booklet for complete information, including eligibility.

 

Health:             Super Care 1 Revision 2003 = $100/$200 deductibles; $5/$10 Prescription Co-pay; $2 Co-pay for Mail-In

                       Maintenance Drugs; includes $5,000 Basic Term Life with AD&D

Medical Rider:  Preventive Care

Medical Rider:  Hearing Aid

Plan Year

    The Plan Year begins July 1, 2005 and ends June 30, 2006. 

How to Enroll

    Complete the Group Application Form available from Human Resources.  Also, if you would like to have your contribution to your insurance deducted on a pre-tax basis, you must also complete a Payroll Reduction Agreement form.  Your contribution rate per paycheck will be:                                        

Single = $43.48               Two-Person = $113.75                Family = $113.75

Contact Information: 

    FAX Claims to:   517-333-6229 (include your social security number and our group number 66585)

Disability Claims                     800.247.6951	Medical Claims           800.336.0013
Field Services                         800.292.4910	Membership                888.888.4168
Hospital Precertification           800.336.0022	RaeNae Ballard           800.292.4910, Ext. 5570
Legal and Compliance             800.292.4910

 

When traveling out-of-state:

Non-Michigan pharmacists:   Call PAID Prescriptions at 800.922.1557.  PAID group number is BCBSMLG. 

 

Participating providers:   Bill Blue Cross Blue Shield of Michigan, 600 East Lafayette, Detroit, MI 48231-2998   Ph:  800.810.2583 

 

Non-participating providers:   Bill MESSA directly at the address at the top of this page.  Non-participating providers set their own fee. You are responsible for the difference between the BCBSM approved amount and the non-participating provider’s total fee. Some non-participating providers will still bill BCBSM/MESSA for the approved amount, while others require payment-in-full from you. You are then responsible for submitting receipts to MESSA for reimbursement of the approved amount.

Major Medical Expense Insurance.......................................................Unlimited Lifetime Benefit

 

Inpatient Hospital Coverage

    Room and board and necessary medical services.................................Covered Services Paid in Full

               Pre-admission review required for non-emergency admittance.  Pre-admission review required within 72 hours of

              emergency admittance.

 

Outpatient Hospital Coverage

    Emergency accident or injury.............................................................100% of approved amount

    Emergency illness............................................................................. 90% of approved amount

    Outpatient surgery............................................................................100% of approved amount

    Radiation therapy and chemotherapy..................................................100% of approved amount

 

Surgery & Anesthesia Coverage

    Participating provider.........................................................................Covered Services Paid in Full

    Non-participating provider:

              Surgeon's charges..................................................................100% of approved amount

              Assistant surgeon's charges....................................................100% of approved amount

              Anesthesiologist's charges......................................................100% of approved amount

In-Hospital Medical Visits...................................................................100% of approved amount

Diagnostic X-ray and Laboratory (Outpatient)....................................100% of approved amount

Cancer Screening Exams and Tests...................................................100% of approved amount

Home Health Care Coverage.............................................................100% of approved amount

Hospice Care Coverage.....................................................................100% up to annual maximum

MESSA Nurseline and Healthy Expectations -- 800-414-2014

    MESSA Nurseline and Healthy Expectations are MESSA services that provide members with 24-hour access to trained health care professionals and an extensive audio library of medical information.  Nurseline is a health information line staffed around the clock by registered nurses trained to answer medical questions and offer guidance.  Members can call Nurseline and speak with a nurse or listen to pre-recorded topical information.   Healthy Expectations provides support for expectant mothers.

Medical Case Management (MCM) Services

    Medical Case Management (MCM) is an additional benefit for members when a catastrophic medical problem occurs.  MCM plans are tailored to an individual member's unique needs.   Medical Case Management services are designed to help members maximize the value and benefits of their Super Care I plan while ensuring that their particular medical needs are met.  With MCM a MESSA Case Manager serves as a personal liaison between the patient, health care team, community resources and MESSA.  The MESSA case manager provides suggestions and coordinates the continuity of care from the onset of illness through long term rehabilitation.  Final decisions remain with the covered patient, his or her family and doctor.

 

Human Organ Transplants  [$1 million transplant benefit maximum during a benefit period]

    Covered charges for heart, heart & lung, liver, small intestine, pancreas anti-rejection drugs, office visits, home health care, visiting nurses, surgical, storage and transportation costs, and organ procurement........100% of approved amount

 

Miscellaneous Charges - After satisfaction of the annual deductible, miscellaneous covered charges are reimbursed at 90% for

                                       the remainder of the calendar year.                                         

    Outpatient psychiatric (maximum 50 annual visits)................................................ 90% of approved amount

    Skilled nursing facility room and board................................................................. 90% of approved amount

    Physician charges, private duty nursing (RN-LPN),

    professional ambulance, oxygen, blood and plasma,

    artificial limbs, prosthetic devices, braces............................................................ 90% of approved amount

How the Program Works

MESSA Preferred Rx prescription drug program promotes the use of generic drugs over brand name drugs where medically appropriate.   The co-pay is $5 per generic prescription or refill, or $10 if requesting a brand name drug. 

In the following cases, a brand name drug can be purchased with a $5 copayment:

	The physician tells the pharmacist to dispense as written (DAW) for medical reasons.
	There is no equivalent Class A generic drug.**

** Class A generics are therapeutically equivalent to their brand name counterpart.  The means that the generic contains identical amounts of the same active ingredients in the same dosage form, is administered in the same way, and is absorbed at the same rate and extent as the brand name drug.

Mail-Order Maintenance Drugs and supplies:  The MESSA Preferred Rx program also gives members the option of purchasing maintenance prescription drugs through the Mail Service Program with a $2. co-pay per prescription or refill for a 90-day supply.  Forms are available from Human Resources.

Pharmacy Network:  The Preferred Rx network includes most pharmacies in Michigan plus many out-of-state pharmacies.  You can use your MESSA/BCBSM identification card nationwide at pharmacies that participate in the Preferred Rx network. 

Out-of-Network Purchases:  Prescription drugs purchased at out-of-network pharmacies are reimbursed at 75 percent of the approved amount, minus the co-pay.  To receive reimbursement, send an itemized receipt to MESSA at the above address.