Member Benefits

Core Benefits

Blue Cross Complete of Michigan wants to help you get, stay and be healthy. That means health care benefits that give you the care you need, when you need it.

Understanding Your Core Benefits

Blue Cross Complete 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.

Complete your health assessment

A health assessment is a short screening about your health and how you live. Complete the assessment so we can help you with your health and basic needs. We can refer you to resources in your community for food, housing, utilities and more. We can also connect you to a care manager to help address your needs through an individualized plan.

The health assessment is easy to fill out. You can complete your health assessment online or over the phone. It should take less than 10 minutes to complete.

To complete your health assessment online, log in to your online account by clicking Login at the top of this page. Once you’re logged in, click Health Assessment to get started. Or, call 1-877-375-3231 to complete your assessment over the phone.

Prior authorization

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.

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.

Interpreter services

We can get an interpreter to help you speak with us or your doctor in any language. We also offer our materials in other languages. Interpreter services and translated materials are free of charge. Call Customer Service at 1-800-228-8554 (TTY: 1-888-987-5832) 24 hours a day, seven days a week for help getting an interpreter or to ask for our materials in another language or format to meet your needs. Blue Cross Complete complies with all applicable federal and state laws with this matter.

¿Habla español? Por favor contacte a al Servicios al Miembro.

Comparta sus comentarios sobre los servicios de idiomas. Realice la encuesta.

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.

Regular Medicaid redetermination

Now that the Covid-19 public health emergency has ended, regular Medicaid redetermination has resumed.

When it’s your turn to renew, you may receive a benefit renewal packet from the Michigan Department of Health and Human Services. Fill out and return your form as soon as you can. If you don’t return your form on time, you and your family may lose your Medicaid benefits.

Wondering when it’s your time to renew? You can look up your renewal date in MI Bridges in the View Benefits module.

Checklist to renew your Medicaid benefits:

  • Fill out your renewal form. You’ll need the social security number of each person covered.
  • Gather needed documents, such as copies of any W-2 forms and pay stubs.
  • Return your review form and documents to MDHHS by the due date.

If you told the state that you prefer mailed information, you may receive your benefit renewal packet by mail. You’ll have about 60 days to complete your form and mail it to the address provided on your form. You also have the option to complete the form and upload your documents online in MI Bridges.

If you told the state that you prefer to receive electronic communication, you’ll receive a text message with a link to MI Bridges. There, you can complete your renewal form and upload paystubs, tax forms or W-2s.

You can also submit your renewal packet by faxing it to 1-517-346-9888.

If you don’t speak English, language assistance services are available at no cost to you. Call 1-800-228-8554 (TTY: 1-888-987-5832).

Make sure MDHHS can reach you when it’s your time to renew. Check that your phone number, address and email address are correct. 

  • Visit michigan.gov/mibridges and make updates to your MI Bridges account.
    • Make your updates in both the Profile section and the Report Changes area
  • If you need to create an account, select Register.
  • If you’re a returning enrollee, select Login. If you have trouble logging into MI Bridges, call the MI Bridges Hotline at 1-844-799-9876 (TTY: 1-833-285-5910).

If you don’t qualify for Medicaid coverage anymore, Blue Cross Complete will no longer be your health insurance plan. However, you and your family may be eligible for another health plan offered through the Health Insurance Marketplace. The Marketplace has many health plan options that you can choose from.

  • To shop and compare available plans on the Health Insurance Marketplace, visit healthcare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325). Thanks to savings recently put in place by the federal government, many Michiganders are eligible to buy a Marketplace plan for less than $10 per month. 

If you’re interested in a Blue Cross Blue Shield of Michigan plan offered through the Marketplace, here’s what you can do:

  • Call 1-855-890-2409 Monday through Friday from 8 a.m. to 6 p.m. to speak to a BCBSM advisor to discuss plan options that fit your health care and budget needs. We’ll also see if you qualify for plans with low or no monthly premiums and other special cost savings.
  • Visit bcbsm.com/medicaidloss to learn more about health plan options and how to sign up.

Blue Cross Complete cares about your well-being. Did you receive your redetermination form and need help with the renewal process? Call Customer Services at 1-800-228-8554 (TTY: 1-888-987-5832). You can also contact your MDHHS case worker or local MDHHS office with questions.

Grievances and Appeals

We want you to be happy with the services you get from Blue Cross Complete and our providers. If you are not satisfied, you can file a grievance or appeal.

Grievances are complaints that you may have if you are unhappy with our plan or if you are unhappy with the way a staff person or provider treated you. Appeals are complaints related to your medical coverage, such as a treatment decision or a service that is not covered or denied. If you have a problem related to your care, talk to your provider. Your provider can often handle the problem. If you have questions or need help with the appeal process, call Blue Cross Complete at 1-800-228-8554 (TTY: 1-888-987-5832). To learn more about the grievance and appeals process, view the Grievance and Appeals Fact Sheet (PDF).

Important forms and documents

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

Authorization for Disclosure of Health Information form
The Authorization for Disclosure of Health Information form (PDF) allows Blue Cross Complete to share your health information with the people or organizations that you choose.

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.

Personal Representative Request Form
The Personal Representative Request Form (PDF) allows you to appoint an individual to act on your behalf and make decisions regarding your health.

Request to Access or Inspect Protected Health Information in a Designated Record Set
The Request to Access or Inspect Protected Health Information in a Designated Record Set form (PDF) allows you to request access to records Blue Cross Complete uses to assist you with your medical coverage.

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