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State of Michigan

Comparison of Health Care Options

Other Services continued...

State Health Plan PPO

HMO Benefits

In-network

Out-of-network

Private duty nursing

Covered 90% after deductible

Covered

Wig, wig stand, adhesives

Laser eye surgery (MSEA employees only)

Hearing care

Upon meeting medical conditions, eligible for a lifetime maximum reimbursement of $300. (Additional wigs covered for children due to growth).

Check with your HMO

$755 lifetime limit

Check with your HMO

$15 co-pay for office visit

Not covered

6

Check with your HMO

6

Not all areas have a network of hearing providers. If there is no network in your area, your provider may participate on a per claim basis. If your provider does not wish to participate, you may pay for services and submit a claim. You will be reimbursed up to the allowed amount for covered services.

In-network

Out-of-network

Mental Health Benefits - Inpatient

Covered 100% up to 365 days per year

7

Covered 50% up to 365 days per year

Mental Health Benefits - Outpatient

As necessary 90% of network rates 10% co-pay

As necessary 50% of network rates

Alcohol & Chemical Dependency Benefits -Inpatient

8

Covered 100% Halfway House 100%

8

Covered 50% Halfway House 50%

Alcohol & Chemical Dependency Benefits - Outpatient

$3,500 per calendar year 90% of network rates 10% co-pay

9

$3,500 per calendar year 50% of network rates

Check with your HMO

7

Inpatient days may be utilized for partial day hospitalization (PHP) at 2:1 ratio. One inpatient day equals two PHP days.

8

Up to two 28-day admissions per year. There must be at least 60 days between admissions. Inpatient days may be utilized for intensive outpatient treatment (IOP) at 2:1 ratio. One inpatient day equals two IOP days.

9

$3,500 per calendar year limitation pertains to services for chemical dependency only.

Mental Health/Substance Abuse

State Health Plan PPO

HMO Benefits

7

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