Update on Benefits for 2015
As of January 2015 UAW Retiree Medical Benefits Trust returned our Dental and Vision.
If you have the Cobra Coverage it will continue automatically unless you dis-enroll.
Once you dis-enroll you will never be able to get the life time Cobra again.
If you wish to keep the Cobra this will be your primary Trust will be your secondary.
To Dis-enroll the phone number is as follow:
GM retirees: 1800-489-4646
Chrysler retirees: 1888-409-3300
Delta Dental sent out a package in November 2014: no card is needed for this coverage.
Davis Vision sent out a package in November 2014 with your ID card enclosed.
Vision and Dental Customer Service Numbers
Delta Dental 800-524-0149
Davis Vision: 888-234-5164
Client Control Code 3642
-Medicare PPO Plan waived for 2015
Urgent Care: Retail Clinics approved site for Urgent care service and treatment.
MUST BE IN-NETWORK CLINICS ONLY. Contact your Health Plan for in-network
clinic in your area.
$385 Single In-network
$650 Family In-network
$1000 Single out of Network
$1700 Family out of Network
Max out of pocket:
$755 Single in network
$1395 Family in network
$3000 single out of network
$5550 family out of network
Coinsurance: 10% in-network 30% out of network
For Non Medicare:
6 office visit @$25 copay
Specialists not covered under the 6 visit
Urgent care and Emergency Copay have not changed from last year.
Medicare Advantage PPO Plans:
deductible $245 per person in network
$490 per person out of network
Max out of pocket
-$630 per person in network
-$1395 per person out of network
Coinsurance; 10% in network 30% out of net work
Office visit:$20 copay
Urgent care $25
deductible $385 Single
Office visit: $25
$50 non Medicare
125 Non Medicare
HMO do not have coinsurance or out of pocket maximums.
Once deductible is met you will be responsible for your copay
Some web page that may help:
BCBCMI.COM - Blue Cross Blue Shield
Special Assigned Benefit Rep.: Debbie Garcia Toll free: 1866-854-9756