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State of Michigan

Comparison of Health Care Options

Mammography1

State Health Plan PPO

HMO Benefits

In-network

Out-of-network

Annual standard film mammography screening (covers digital mammography up to the standard film rate)

Covered 100% Not subject to preventative maximum

Covered 90% after deductible Not subject to preventative maximum

Covered 100%

1

American Cancer Society guidelines apply

Physician Office Services

State Health Plan PPO

In-network

Out-of-network

Covered

$15 co-pay,

Covered 90%

deductible not

after deductible

applicable

Covered 100% after

Covered 90% after

deductible

deductible

Office visits, consultations and urgent care visits

Outpatient and home visits

Emergency Medical Care2

HMO Benefits

$10 co-pay

State Health Plan PPO

HMO Benefits

In-network

Out-of-network

Hospital emergency room for medical emergency or accidental injury

Covered 100% after a $50 co-pay if not admitted

$50 co-pay if not admitted

Ambulance services – medically necessary

Covered 100% after deductible

Covered 100%

2

Emergency room and physician charges are covered 100% under the Catastrophic Health Plan. Ambulance is covered $25 maximum.

3

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