Q. What is Medical Case Management?
A. Medical Case Management, is an additional benefit available when a catastrophic medical problem occurs i.e., neurological injury (brain & spinal cord, multiple sclerosis, amyotrophic lateral sclerosis), premature and high risk infants, trauma victims (burns, multiple fractures), amputations, cancer, AIDS, and Crohn's Disease. MESSA assigns a Case Manager who functions as a personal liaison between the patient/family, health care team, community resources and MESSA, providing suggestions and coordinating the continuity of care from the onset of illness into the long term rehabilitation. Final decisions remain with the covered patient/family and doctor.
Q. What does "Approved Amount" Mean?
A. Means up to the "Approved Amount".
A participating provider’s charges will not exceed "R&C" since they have signed a contract with BCBSM agreeing to accept their benefit determination as payment in full, and to only bill you for any deductible and co-payments or for services not covered under your Super Care 1 or Choices II plan.
Q. I'm having a problem with a claim being paid, is there anything I can do?
A. Yes, you can call the MESSA toll free telephone number 1-800-336-0013. When using the 800 number ask the customer service representative for his/her name.
Always have your contract number ready. This is the number listed on your medical card.
Collect relevant information such as, explanation of benefits forms, itemized bills, name of doctor or dentist, and any other relevant information.
Q. What happens if I become ineligible, or eligible, for other medical coverage during the year? May I change my enrollment?
A. Yes. If you experience a Status Change, as defined in the
List of Status Change Events,
you have 30 DAYS from the time of the status change to change your election.
Q. Can you switch medical plan coverage under COBRA?
A. Flexible benefits program participants are eligible for
COBRA rights with respect to the medical benefits elected for the plan year. For example, if you elected Choices II under
CMU Choices, you can not change to SuperCare I under COBRA until open enrollment. Changing to a new plan can be made only during the annual open enrollment period.
Q. I elect to have no coverage under CMU Choices because I am covered under my spouse's plan. If my spouse has a significant change in the level or kind of coverage, may I come back into CMU Choices?
A. Yes. But remember, you must advise the Benefits Office of the
change within 30 days of the event.
Q. How long are my children eligible to be included in coverage?
A. They are eligible for coverage from birth through the end of the calendar year of the child's 26th birthday regardless of the child's residency, marital status, student or financial dependency status.
Children over the age of 26 can be covered on MESSA if they are a full time student, and are currently covered at the time they are 26 years old. Each year MESSA will require proof that your child is a full time student. MESSA makes the final decision.
Your spouse is not eligible for
CMU Choices coverage in the medical plan as a dependent if he or she is already covered as an employee under a CMU plan.
Q. How does Coordination of Benefits and the Birthday Rule Apply?
A. The CMU health plans use the National Association of Insurance Commissioners (NAIC) model to determine which medical plan will cover dependent children as primary when both parents have plans that cover the children. Briefly, for parents of the dependent child who are not legally separated or divorced, the primary plan is the plan of the parent whose birthday (month and day) falls earlier in the year. The secondary plan is the plan of the parent whose birthday falls later in the year.