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BCN Advantage HMO-POS
2021 plan information
BCN AdvantageSM is a HMO-POS plan with a Medicare contract.
Enrollment in BCN Advantage depends on contract renewal.
FOR UAW TRUST MEDICARE MEMBERS
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Our website is www.bcbsm.com/uawtrust.
Discover BCN Advantage HMO-POS
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Look through your benefits.
BCN Advantage can give you peace of mind.
Questions about doctors
or hospitals? Call us at 1-877-396-1893, Monday through Friday
from 8 a.m. to 5 p.m. Eastern time, for up-to-date information or
visit www.bcbsm.com/UAWTrust to learn more. TTY users, call
711.
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Our growing network of providers
Cost sharing and understanding important terms
Summary of frequently used benefits
Get the card that gives you more 9
Important information and coverage map 10
Contents
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Our growing network of providers is ready to meet your health
care needs
We offer nearly 6,000 primary care physicians, over 51,000
specialists and 140 hospitals in our service area, including
Bronson and Spectrum hospitals, health centers and physicians.1
Zero dollar monthly contribution.*
Zero percent coinsurance.
Unlimited office visits with low copayments.
Referrals aren’t always required if the specialist is in the
plan’s network.
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
BCN Advantage offers:
1Source: BCN Medical Informatics Statewide Provider Counts
report July 1, 2020.
*You must continue to pay your Medicare Part B premium.
Stay healthy
We offer educational materials, reminders and other support for
members with chronic conditions, like chronic obstructive pulmonary
disease, depression, diabetes, heart disease, heart failure and
kidney disease.
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Nearly 6,000 primary care providers in 68 counties throughout
Michigan.
Online visits.
Complete flexibility in your choice of plan. If you change your
mind after switching to BCN Advantage, you can still switch to
another qualified plan.
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
The choice is yours
In most cases, if you already receive Social Security you may
have enrolled in Medicare Part A and B. If you have not received
your Medicare card showing enrollment in parts A and B, you should
contact Social Security to verify enrollment. Enrollment in Part B
is required. If you wish to enroll in another plan, call Retiree
Care Connect at 1-866-637-7555, Monday through Friday from 8:30
a.m. to 4:30 p.m. Eastern time, to discuss your options. TTY users
call 711.
Plan changes are effective the first day of the second month
following the date of your change request, but no earlier than
Jan.1, 2021.
The UAW Trust offers BCN Advantage HMO-POS as one of the
Medicare Advantage health plans for consideration by its
Medicare-eligible members.
The UAW Trust provides health care benefits for UAW retirees and
their eligible dependents. BCN Advantage is designed to promote
healthy living, give you access to the doctors and hospitals you
want, and provide the most value for your health care dollar.
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2021 Cost share summary
Deductible Note: Deductible doesn’t apply to Protected Class.
Protected Class members are responsible for copays only.
$400 per member
$675 per family
Percent coinsurance None
Maximum out-of-pocket$1,000 (includes deductible and fixed
dollar copays —
all coinsurance is 0%)
Dollar maximums None
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Deductible, coinsurance, copayments and dollar maximums
Payment amounts are based on the Blue Care Network approved
amount, less any applicable deductible and copay amounts required
by the plan. This coverage is provided in keeping with a contract
with the federal government. Some tests, prescription drugs or
other services may require prior authorization arranged by the
member’s primary care physician or health care plan.
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5
2021 Cost share summary
Deductible — the amount you pay annually before your plan begins
to pay. This doesn’t apply to services that require a copay.
Copay — a fixed amount you pay to receive a medical service,
usually at the time of service (office visits, emergency room,
urgent care).
Maximum out-of–pocket — the most you will pay in deductibles and
fixed dollar copays during the year.
January 1 Beginning of coverage period
Deductible is met In network:
$400 per member/$675 per family
Deductible (you pay)
Insurance pays 100%
December 31 End of coverage period
Understanding important termsImportant terms/de�nitions Hospital
care Call/nursing telephone support Hospital and other services
Alternatives to hospital carePlan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
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6
2021 Summary of frequently used benefits
Preventive services*
Routine eye exam — VSP: 1-800-877-7195$25 copay covered
once every 12 months
Health maintenance exam Covered — 100%
Annual gynecological exam Covered — 100%
Medical nutritional therapy Covered — 100%
Diabetes self-management training Covered — 100%
Pap smear screening — laboratory services only Covered —
100%
Immunizations Covered — 100%
Prostate specific antigen screening — laboratory services
only
Covered — 100%
Mammography screening Covered — 100%
Annual colorectal cancer screening Covered — 100%
Physician office servicesPrimary care physician office visits
Covered — $25 copay per visit
Online visits Covered — $25 copay only
Specialist visits**Covered — $35;
Protected Class $25 copay per visit
Emergency medical careHospital emergency room — copay waived if
admitted; inpatient hospital benefits apply
Covered — $50 copay per visit; Ford Protected Class $0 copay per
visit
Urgent care center Covered — $25 copay per visit;
Ford Protected Class $0 copay per visit
Ambulance services — medically necessaryCovered — 100% after
deductible,
ground and air service
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
We might ask you to check in with us before having certain
tests, treatments or surgeries, or getting certain prescription
drugs filled; this is called a prior authorization.
* For all preventive services covered at no cost under Original
Medicare, we also cover the service at no cost to you. However, if
you’re treated or monitored for a new or existing medical condition
during the same preventive service visit, a copay will apply for
the care received for the medical condition.
**Your BCN Advantage plan doesn’t require a referral for you to
see a specialist. If the specialist you choose is in your plan’s
network you can make an appointment for an initial consultation
without a referral from your primary care physician. Some
specialists may still ask for a referral, because they only accept
patients whose primary care doctor confirms the patient needs
specialty care.
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
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7
Diagnostic services
Laboratory and pathology testsCovered 100%; office visit copay
may apply per member, per visit
Diagnostic tests and X-rays Covered — 100% after
deductibleRadiation therapy Covered — 100% after deductible
Maternity services provided by a physicianPrenatal and postnatal
care Covered — $25 copay per visit
Delivery and nursery careCovered in full for professional
services after deductible
Hospital careInpatient physician care, general nursing care,
hospital services and supplies
Covered — 100% after deductible, unlimited days
Outpatient surgery Covered — 100% after deductible
Alternatives to hospital care
Skilled nursing careCovered — 100% after deductible, up to 100
days per benefit period, renewable
after 60 days of nonconfinementHospice care Covered — 100% after
deductibleHome health care Covered — 100% after deductible
Surgical servicesSurgery — includes all related surgical
services and anesthesia
Covered — 100% after deductible
Human organ transplantsCovered — 100% after deductible,
subject to medical criteria
Mental health care and substance abuse treatment
Inpatient mental health care
Inpatient substance care — covered at 100%, up to 190 days per
Medicare lifetime maximum.
Additional renewable 45 days per episode of illness after
Medicare
benefit is exhausted and 60 days of nonconfinement. Approval
required.
Substance abuse care Covered — 100%, unlimited daysOutpatient
mental health care Covered — 100%, unlimited visitsOutpatient
substance abuse care Covered — 100%, unlimited visits
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye careImportant terms/de�nitions Hospital care Call/nursing
telephone support Hospital and other services
Alternatives to hospital carePlan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
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8
Other servicesAllergy testing and therapy Covered — 100% after
deductibleAllergy injections Covered — 100%; office visit copay
may
apply per member, per visitChiropractic spinal manipulation —
when referred Covered — $20 copay per visitAcupuncture — when
referred Covered — $20 copay per visitOutpatient physical, speech
and occupational therapy
Covered — 100%, after deductible (no visit limit)
Infertility treatment Not covered — exclusion includes
infertility drugs, in vitro fertilization
and artificial inseminationDurable medical equipment Covered —
100%Prosthetic and orthotic appliances Covered — 100%Hearing aid –
hearing examination and aid covered once every 36 months
Covered in full — standard hearing aid; office visit copay may
apply for
examination; binaural hearing aids every 36 months if younger
than 19
SilverSneakers® fitness program Covered — 100%
2021 Summary of frequently used benefits Important
terms/de�nitions Hospital care Call/nursing telephone support
Hospital and other services
Alternatives to hospital carePlan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
The eyes have it
• Get a routine eye exam every 12 months.
• Receive a 20 percent discount on glasses.
For details, call VSP® Vision Care at 1-800-877-7195 or visit
online www.vsp.com.
Routine and follow-up care must be pre-authorized by your
primary care doctor and arranged through BlueCard.
You may call 1-800-MEDICARE (1-800-633-4227), or visit
www.medicare.gov for more information about Medciare benefits and
services, including general information about the health or
prescription drug benefits. TTY users, call 1-877-486-2048. Hours
are 24 hours a day, seven days a week.
Important information
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9
Get the card that gives you more
Exceptional health and wellness support, including MyBlueSM
Concierge, that provides personalized one-on-one service,
including:
– Explanation of your benefits
– Fast connection to our care support and customer service
teams
– Guidance on preventive measures and services
– Support on proactive steps to maintain and improve your
health
Easy online tools that help you take charge of your health
Access to our 24-Hour Nurse Line
In-Home Visits at no additional cost through our partnership
with Signify Health. A complete health and wellness assessment from
the privacy of your home with a licensed medical doctor or nurse
practitioner, one of three ways:
1. In-person in your home
2. Video conference — on your smart phone, tablet or
computer
3. Over the telephone
For more information or to schedule an In-Home Visit go to
www.bcbsm.com/uawtrusthomevisits, or call Signify Health at
1-844-226-8216. TTY users call 711.
Free SilverSneakers® fitness program at more than 17,000 fitness
locations:
– SilverSneakers group exercise classes, exercise equipment,
pool, sauna and many other features
– Classes designed for your fitness level and informative
seminars
Fitness services must be provided at SilverSneakers
participating locations. You can find a location or request
SilverSneakers Steps information at www.silversneakers.com or call
1-866-584-7352, Monday through Friday, from 8 a.m. to 8 p.m. TTY
users call 711.
Your BCN Advantage ID card gives you:
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
Important terms/de�nitions Hospital care Call/nursing telephone
support Hospital and other servicesAlternatives to hospital
care
Plan bene�ts Ready to join
Who can join
Beyond original medicare Other services Mental health and
substance abuse treatment
Leaving the hospital Questions DME
SilverSneakers Preventive care Prescription drugs Deductible,
coinsurance and dollar maximums
Reasons to join
Physicians/Providers
Internet/bcbsm.com/online/live coaching
MyBlue Medicare Magazine Physician o�ce services Outpatient
diagnostic services Surgical services hearing
Everyday savings Tobacco cessation Emergency services Coping
with heart failure or COPD Facing a complex medical condi-tion
Where am i covered
Pneumonia
Research monitors
Missouri
Shot
Customer service
Member
Maternity care
Eye care
SilverSneakers is a registered trademark of Tivity Health, Inc.
© 2020 Tivity Health, Inc. All rights reserved. Tivity Health is an
independent corporation retained by Blue Care Network to provide
health and fitness services to its BCN Advantage HMO-POS
members.
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10
Online member account
Your Blue Cross member account gives you access to personalized
benefit information.
• Log on to the website, www.bcbsm.com/UAWTrust
• Click on LOGIN tab (upper right-hand corner)
• Click Register Now
With your member account, you can:
• View your claims
• View and print your EOBs
• Check current out-of-pocket totals for:
– Deductible
– Out-of-pocket maximum
Blue Cross mobile app
Take your Blue Cross plan information with you on our mobile
app.
• Go to the Apple® App Store or Google Play™, and search for
BCBSM
• Download the app
• Tap the app icon
• Tap Register
With the Blue Cross mobile app you can:
• Check deductible and out-of-pocket balances
• View Explanation of Benefits and claims
• Search for doctors
• Learn about Health and Wellness programs
• View your virtual ID card
Access your information, no matter where you are
Apple is a trademark of Apple Inc., registered in the U.S. and
other countries. App Store is a service mark of Apple Inc.,
registered in the U.S. and other countries. Google Play is a
trademark of Google Inc.
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11
GrandTraverse Kalkaska Crawford Oscoda Alcona
Antrim Otsego Mont-morency
CheboyganPresque
Isle
Benzie
Leelanau
Alpena
Emmet
Charlevoix
Montcalm Gratiot SaginawSanilacTuscola
Mecosta
Osceola Clare GladwinArenac
BayMidlandIsabella
Huron
ManisteeWexford
MissaukeeRoscommon
OgemawIosco
Muskegon
NewaygoOceana
Mason Lake
Branch Hillsdale Monroe
KalamazooCalhoun
Jackson WayneWashtenaw
Barry
Ionia Shia-wassee
LapeerGenesee
Ingham LivingstonEaton
Clinton St. Clair
OaklandMacomb
Van Buren
Allegan
Ottawa Kent
St. Joseph
MackinacSchoolcraft
Luce
BCN Advantage is open to UAW Trust members residing in the
68-county area shown on the map. You must receive routine care from
plan providers in this area.
BCN Advantage HMO-POS 2021 service area
St. Joseph ZIP codes served: 49011 l 49030 l 49052 l 49072 l
49093 l 49097
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Multi-language Interpreter Services
Spanish: ATENCIÓN: si habla español, tiene a su disposición
servicios gratuitos de asistencia lingüística. Llame al
1-888-322-5616 (TTY: 711).
Arabic:
برقماتصل.بالمجانلكتتوافراللغویةالمساعدةخدماتفإن،العربیةتتحدثكنتإذا:
ملحوظة711).:والبكمالصمھاتفرقم(1-888-322-5616
Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-322-5616 (TTY:
711)。
Syriac: ܥܒܕܛܝܒܐ܀ ܽܣܘܪܳܝܳܝܐ ܡܓܢܡܥܕܪܝܢܢܘܡܓܢܡܫܡܫܝܢܢܐܢܡܠܠܝܬܘܢ:
ܢܘܗܪܐ܀)TTY: 711(1-888-322-5616:ܡܠܠܥܡܢܥܠܡܢ̈ܝܢܐ
Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ
ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-322-5616 (TTY:
711).
Albanian: KUJDES: Nëse flitni shqip, për ju ka në dispozicion
shërbime të asistencës gjuhësore, pa pagesë. Telefononi në
1-888-322-5616 (TTY: 711).
Korean:주의:한국어를사용하시는경우,언어지원서비스를무료로이용하실수있습니다.1-888-322-5616 (TTY:
711) 번으로전화해주십시오.
Bengali: মেন রাখেবন:: যিদ আপনার ভাষা বাংলা হয়, ভাষা সহায়তা
পিরেষবা, আপিন িবনামেূলয্ েপেত পােরন। কল করন 1-888-322-5616 (TTY:
711)।
Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z
bezpłatnej pomocy językowej. Zadzwoń pod numer 1-888-322-5616 (TTY:
711).
German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen
kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.
Rufnummer: 1-888-322-5616 (TTY: 711).
Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano,
sono disponibili servizi di assistenza linguistica gratuiti.
Chiamare il numero 1-888-322-5616 (TTY: 711).
Japanese: 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-888-322-5616（TTY:
711）まで、お電話にてご連絡ください。
Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам
доступны бесплатные услуги перевода. Звоните 1-888-322-5616
(телетайп: 711).
Serbo-Croatian: OBAVJEŠTENJE: Ako govorite srpsko-hrvatski,
usluge jezičke pomoći dostupne su vam besplatno. Nazovite
1-888-322-5616 (TTY: Telefon za osobe sa oštećenim govorom ili
sluhom: 711).
Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang
gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.
Tumawag sa 1-888-322-5616 (TTY: 711).
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Discrimination is Against the Law
Blue Cross Blue Shield of Michigan and Blue Care Network comply
with applicable Federal civil rights laws and do not discriminate
on the basis of race, color, national origin, age, disability, or
sex. Blue Cross Blue Shield of Michigan and Blue Care Network do
not exclude people or treat them differently because of race,
color, national origin, age, disability, or sex.
Blue Cross Blue Shield of Michigan and Blue Care Network:•
Provide free aids and services to people with disabilities to
communicate effectively
with us, such as:o Qualified sign language interpreterso Written
information in other formats (large print, audio, accessible
electronic
formats, other formats)• Provide free language services to
people whose primary language is not English,
such as:o Qualified interpreterso Information written in other
languages
If you need these services, contact the Office of Civil Rights
Coordinator.
If you believe that Blue Cross Blue Shield of Michigan or Blue
Care Network have failed to provide these services or discriminated
in another way on the basis of race, color, national origin, age,
disability, or sex, you can file a grievance with:
Office of Civil Rights Coordinator600 E. Lafayette Blvd.MC
1302Detroit, MI 482261-888-605-6461, TTY: 711Fax:
[email protected]
You can file a grievance in person or by mail, fax, or email. If
you need help filing a grievance, the Office of Civil Rights
Coordinator is available to help you.
You can also file a civil rights complaint with the U.S.
Department of Health and Human Services, Office for Civil Rights,
electronically through the Office for Civil Rights Complaint
Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone
at:
U.S. Department of Health and Human Services200 Independence
Avenue, SWRoom 509F, HHH BuildingWashington, D.C.
202011-800-368-1019, 1-800-537-7697 (TDD)
Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html.
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Contact information
Enrollment questions
1-877-396-1893 8 a.m. to 5 p.m. Eastern time,
Monday through Friday. TTY users call 711.
www.bcbsm.com/UAWTrust
Current member questions?
UAW Retiree Medical Benefits Trust Service Center
1-800-222-5992 8 a.m. to 5:30 p.m. Eastern time,
Monday through Friday TTY users call 711.
SilverSneakers
1-888-423-4632 8 a.m. to 8 p.m. Eastern time,
Monday through Friday TTY users call 711.
www.silversneakers.com
Delta Dental
1-800-524-0149 www.deltadentalmi.com
Retiree Health Care Connect
1-866-637-7555 8:30 a.m. to 4:30 p.m. Eastern time,
Monday through Friday. TTY users call 711.
Behavioral health and substance abuse care
1-800-431-1059. 8 a.m. to 5 p.m. Eastern time,
Monday through Friday. TTY users call 711.
Emergencies: 24-hours a day, seven days a week.
Prescription drug questions
Express Scripts 1-866-662-0274
Open 24 hours a day, seven days a week (except Thanksgiving and
Christmas).
TTY users call 711.
Davis Vision
1-888-234-5164 www.davisvision.com
Blue Cross Blue Shield of Michigan is proudly
represented by the UAW
W001797H5883_21UAWBnftBrchr_M FVNR 0820CB 17242 JUL 20
