Member Handbook and Certificate of Coverage

Bcluoe Cmrossplete of Michigan Confidence comes with every card.?

Member Handbook and Certificate of Coverage

A guide for all Blue Cross Complete members

Includes:

Preferred Drug List and Specialty Drug Guide

Guidelines to Good Health Certificate of Coverage

Contact us

Customer Service

Customer Service is available whenever you have a question or concern about benefits or services. Customer Service can answer your questions, help you understand your benefits and give you information about our policies. If you need care after hours, we can help you find urgent or emergency care.

Call toll free: 1-800-228-8554 (TTY users should call 1-888-987-5832.)

24 hours a day, seven days a week

Pharmacy Customer Service

Call toll free: 1-888-288-3231 (TTY users should call 1-888-988-0071.)

8:30 a.m. to 6 p.m. Monday through Friday

Write to us: Blue Cross Complete of Michigan

Suite 1300

4000 Town Center

Southfield, MI 48075

Visit us online:

Download our mobile app Download our mobile app by visiting the GoogleTM Play or Apple App? Store. Type "BCCMI" in the search bar.

Other important phone numbers

24-hour Nurse Help Line

1-888-288-1724 (TTY: 1-888-987-5832)

Anti-fraud Unit

1-855-232-7640 (TTY: 711)

Bright Start? maternity program 1-888-288-1722 (TTY: 1-888-987-5832)

Outreach Team

1-888-288-1722 (TTY: 1-888-987-5832)

(health education and resources)

Tobacco quit program

1-800-480-7848 (TTY: 1-888-229-2182)

Transportation1-888-803-4947 (TTY: 711)

Healthy Michigan Plan members: Learn about more phone numbers for you in Part 5: Healthy Michigan Plan, including Dental Customer Service.

The Healthy Michigan Plan is a health care program from the Michigan Department of Health and Human Services. Blue Cross Complete administers Healthy Michigan Plan benefits to eligible members.

MI Child program Michigan ENROLLS

1-888-988-6300 (TTY: 1-888-263-5897) 1-888-367-6557 (TTY: 1-800-975-7630)

Language Services

Please call Customer Service if you need free help in another language or format. If you'd like to speak in another

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Welcome to Blue Cross Complete of Michigan

Blue Cross Complete is one of many plans affiliated with Blue Cross Blue Shield of Michigan. You now carry the most widely recognized health care symbols -- the Blue Cross and the Blue Shield.

Thank you for choosing us to be part of your health care team. We partner with you and your doctor to make sure you get the health care you need, when you need it.

This handbook explains your health plan benefits. It includes your member materials: ? Blue Cross Complete Member Handbook: This explains your covered benefits and medicines, picking a doctor, getting preventive care, living with chronic conditions and more. ? Preferred Drug List and Specialty Drug Guide: These are the medicines we cover. ? Certificate of Coverage: This is your health care contract with us.

Your certificate of coverage appears in this booklet beginning on page 69.

Getting started ? Choose a doctor to be your primary care physician. You must have a primary care doctor in our network to use your benefits. ? If your current doctor is in our network, tell us his or her name. ? If you'd like to choose or change doctors, call Customer Service. ? If you don't choose a doctor, we'll choose one for you.

? Make an appointment with your primary care doctor for a well visit.

? Read through this handbook. It explains how your plan works. You'll read about your benefits, getting and staying healthy, our policies and other information about our health plan.

Healthy Michigan Plan members: Learn more about your plan in Part 5: Healthy Michigan Plan. After joining Blue Cross Complete and picking a primary care doctor, you should: ? Call your primary care doctor for an appointment within 60 days, or at about two months.

? See your doctor for this appointment within 150 days, or at about five months. During this visit, you'll complete a Health Risk Assessment form. You will need to complete a HRA every year.

If you have any questions, please contact us. We look forward to serving you.

About Blue Cross Complete Blue Cross Complete of Michigan LLC is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross Complete is a state-approved Medicaid health maintenance organization.

Please note: ? Blue Cross Complete is not contracting as the agent of the Blue Cross and Blue Shield Association. ? No person, entity or organization other than Blue Cross Complete will be held accountable or liable to you for any of Blue Cross Complete's obligations created under the contract. ? Blue Cross Complete is solely responsible for its own debts and other obligations. 1

Table of contents

Part 1: Your Blue Cross Complete health plan......................................... 4

How to choose a doctor, make an appointment and get care. Your Blue Cross Complete ID card..................... 4 Getting primary and specialty care..................... 5 After hours, hospital and follow-up care............ 6 Choosing a doctor.............................................. 9 Appointments................................................... 10 Copays and reimbursements............................ 12 Our commitments to you................................. 13

Part 2: Your tools and resources...... 15

Use our online tools and resources to change your doctor, get medical and medication history, see your virtual ID card and find doctors and hospitals. Your online account.......................................... 15 Member mobile application............................. 15 SafeLink Wireless? Smartphone........................ 16

Part 3: Your health care benefits...... 17

What's covered by Blue Cross Complete and the state of Michigan. What's covered by Blue Cross Complete......... 17 Vision, hearing and dental................................ 19 Mental health services...................................... 21 Transportation................................................... 21 Extra help and health programs....................... 23 Children's Special Health Care Services........... 24

Bright Start? maternity program....................... 25 Keys to Your Care? text messaging program... 25 Maternal Infant Health program....................... 26 What's covered by the state of Michigan......... 28 An overview of your Blue Cross Complete coverage and benefits...................................... 30

Part 4: Prescription benefits............ 32

Read about your drug benefits, including generic medicines, filling a prescription, finding a pharmacy and the medicines we cover. Medicines covered by Blue Cross Complete... 32 Medicines covered by the state of Michigan.... 34 Preferred Drug List........................................... 35 Specialty Drug Guide..........................................37

Part 5: Guidelines to good health.... 38

Learn more about preventive health care, including recommended tests and screenings, healthy behaviors and important health numbers you should always know. Health information to support your health goals...................................................... 38 Guidelines to good health including pregnancy......................................... 39 Guidelines to Good Health for adults.................45 Guidelines to Good Health for children and teens..........................................46

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Part 6: Healthy Michigan Plan.......... 47

Additional information for Blue Cross Complete members enrolled through the state of Michigan's Healthy Michigan Plan. About the Healthy Michigan Plan..................... 47 Your Blue Cross Complete member ID card..... 47 What the Healthy Michigan Plan covers........... 48 How the Healthy Michigan Plan works............. 49 Your cost sharing and copays........................... 50 Supplemental Certificate of Coverage for Healthy Michigan Plan members...................... 52

Part 7: MIChild................................. 55

Information for members enrolled through the state's MIChild plan.

Part 8: Update your personal records ............................. 56

What to do when your family size changes and how to tell us your wishes for medical care, such as life support. If your family changes....................................... 56 Make your wishes known: Advance directives........................................... 56

Part 9: Your rights and responsibilities................................. 58

To get the most from your health care, follow these rights and responsibilities. Member rights.................................................. 58 Member responsibilities................................... 59 Help identify health care fraud, waste or abuse.................................................. 60

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Part 10: If you have a concern......... 62

What to do if you have a complaint or would like to appeal a medical decision. Grievances and appeals................................... 62

Part 11: Your privacy........................ 66

How we handle your private and confidential information. Our commitment to your privacy..................... 66 Your information. Your rights. Our responsibilities........................................... 67

Part 12: Notice of nondiscrimination and language services...................... 72

We comply with federal nondiscrimination and language services laws.

Part 13: Our Board of Managers...... 74

The Blue Cross Complete Board of Managers helps adopt and put in place the policies that say how Blue Cross Complete runs.

Certificate of Coverage.................... 75

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