15560MI0350003 Blue Cross® Premier PPO Silver 2025 Health Insurance Plan

Blue Cross Blue Shield of Michigan offers this marketplace health insurance plan (Plan ID 15560MI0350003) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: PPO CSR: Standard Silver Off Exchange Plan Issuer: Blue Cross Blue Shield of Michigan

Telehealth Data pending HSA eligible No Dental Not listed Vision Child

Pay / Manage Plan View issuer site

Issuer actuarial value: 70.01%. Expect to pay roughly 29.99% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 70.14% (29.86% member share on average). Learn about AV methodology.

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$320 – $1783

Before subsidies

Estimate after subsidies

Deductible

$3,000

$6000 per group

See deductible details

Max out-of-pocket

$9,000

$18000 per group

Review MOOP rules

Office visits

Primary care $30.00 Copay after deductible

Specialist $50.00 Copay after deductible

HSA Not eligible

Drug tiers

Generic $15.00 Copay after deductible

Preferred brand $100.00 Copay after deductible

View formulary tiers

$495 / mo before subsidies

≈ $5942 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

Ideal for shoppers comparing Bronze vs. Silver budgets.
Update your Marketplace application to apply premium tax credits.

$1553 / mo before subsidies

≈ $18635 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1896 / mo before subsidies

≈ $22750 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

Use this estimate before adding childcare, dental, or vision extras.
CSR Silver variants can lower deductibles dramatically for eligible incomes.
This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1191 / mo before subsidies

≈ $14298 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

Great for households deciding between PPO and HMO networks.
Telehealth and HSA perks (when offered) apply to both members.

Issuer profile See benefits

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

$250.00 Copay after deductible, 20.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Michigan). Submit changes before the deadline to avoid a coverage gap.

Enroll by Dec 15 for Jan 1 starts.
Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

Report the event within 60 days.
Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

Enter accurate income to maximize Advanced Premium Tax Credits.
Standard Silver Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

Match provider networks so ongoing care isn’t disrupted.
Confirm prescriptions stay on-formulary or budget for tier changes.

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

$250.00 Copay after deductible, 20.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID	15560MI0350003
Coverage year	2025
State	Michigan
Issuer	Blue Cross Blue Shield of Michigan
Formulary document	Download formulary
Marketing materials	View marketing kit
Variant ID	15560MI0350003-00
Available variants	Standard Off Exchange Plan · 15560MI0350003-00 Standard On Exchange Plan · 15560MI0350003-01 Open to Indians below 300% FPL · 15560MI0350003-02 Open to Indians above 300% FPL · 15560MI0350003-03 73% AV Silver Plan · 15560MI0350003-04 87% AV Silver Plan · 15560MI0350003-05 94% AV Silver Plan · 15560MI0350003-06
Last plan update	Wed, 14 Aug 2024 00:00 GMT
Last HealthPorta import	Tue, 02 Dec 2025 06:13 GMT

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Michigan N/A

PCPs in Michigan N/A

Telehealth support Data pending

Nationwide providers N/A

Provider network(s)

NULL

Providers	Michigan	All US states
All	N/A	N/A
PCP	N/A	N/A
Allergy	N/A	N/A
OB/GYN	N/A	N/A
Dentists	N/A	N/A

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier	Covered drugs
GENERICS	3,782
NON-PREFERRED-SPECIALTY	1,007

Prior authorization	Drugs
Required	0
Not Required	4,789

Step therapy	Drugs
Required	0
Not Required	4,789

Quantity limits	Drugs
Has Limit	0
No Limit	4,789

Issuer: Blue Cross Blue Shield of Michigan · Plan ID 15560MI0350003 · 2025 filing.
Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
Download the latest formulary directly from the issuer here.
Review marketing brochures and SBC PDFs via the issuer marketing repository.
Variant 15560MI0350003-00 (Standard Off Exchange Plan) currently displayed.

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Chiropractic, osteopathic manipulative, physical and occupational therapy limited to a combined maximum of 30 visits per member per calendar year.

Exclusions: nan

Diabetes Education

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Follows Medicare guidelines.

Exclusions: nan

Home Health Care Services

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 20.00% Coinsurance after deductible

BCBSM-participating agencies only.

Exclusions: Housekeeping and custodial services.

Laboratory Outpatient and Professional Services

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$30.00 Copay after deductible

Tier 1 in-network $30.00 Copay after deductible

Out-of-network 40.00% Coinsurance after deductible

Includes virtual, retail health clinic and medical evaluation at an affiliated immunization pharmacy visits. No charge for 24/7 medical virtual visits when performed through the BCBSM selected vendor app, except HSA eligible plans have no charge after deductible. Diagnostic and laboratory services are not included in the office visit copayment. These services are subject to the plan's deductible and coinsurance, if applicable.

Exclusions: nan

Preventive Care/Screening/Immunization

0.00%

Tier 1 in-network 0.00%

Out-of-network 40.00% Coinsurance after deductible

You may have to pay for services that arent preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$30.00 Copay after deductible

Tier 1 in-network $30.00 Copay after deductible

Out-of-network 40.00% Coinsurance after deductible

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Physical, occupational, chiropractic and osteopathic manipulative therapy limited to a combined maximum of 30 visits per member per calendar year.

Exclusions: nan

Rehabilitative Speech Therapy

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

nan

Exclusions: nan

Specialist Visit

$50.00 Copay after deductible

Tier 1 in-network $50.00 Copay after deductible

Out-of-network 40.00% Coinsurance after deductible

No charge for 24/7 medical virtual visits when performed through the BCBSM selected vendor app, except HSA eligible plans have no charge after deductible. Diagnostic and laboratory services are not included in the office visit copayment. These services are subject to the plan's deductible and coinsurance, if applicable.

Exclusions: nan

Urgent Care Centers or Facilities

$75.00

Tier 1 in-network $75.00

Out-of-network 40.00% Coinsurance after deductible

When the urgent care visit is for an emergency or accidental injury, in-network cost-sharing applies.

Exclusions: nan

X-rays and Diagnostic Imaging

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Prior authorization is required.

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

BCBSM-participating hospitals only. These services require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Dialysis

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Durable Medical Equipment

50.00% Coinsurance after deductible

Tier 1 in-network 50.00% Coinsurance after deductible

Out-of-network 70.00% Coinsurance after deductible

Prescription is required. Rental and purchase limited to basic equipment.

Exclusions: Bath, exercise and deluxe equipment and comfort and convenience items.

Emergency Room Services

$250.00 Copay after deductible, 20.00% Coinsurance after deductible

Tier 1 in-network $250.00 Copay after deductible, 20.00% Coinsurance after deductible

Out-of-network $250.00 Copay after deductible, 20.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 20.00% Coinsurance after deductible

Includes air and ground transportation.

Exclusions: Transportation for convenience.

Hospice Services

No Charge after deductible

Tier 1 in-network No Charge after deductible

Out-of-network No Charge after deductible

BCBSM approved hospice programs only. Coverage includes inpatient and outpatient hospice care.

Exclusions: Housekeeping services.

Inpatient Hospital Services (e.g., Hospital Stay)

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

BCBSM participating hospitals only. These services require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Inpatient Physician and Surgical Services

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

BCBSM participating hospitals only. These services require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Mental/Behavioral Health Inpatient Services

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

BCBSM approved facilities only. These services require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$30.00 Copay after deductible

Tier 1 in-network $30.00 Copay after deductible

Out-of-network 40.00% Coinsurance after deductible

Copayment applies to providers office, virtual visit and applied behavior analysis (ABA) treatment by participating BCBSM provider and virtual care visit from BCBSM selected vendor app only. Additional services are subject to the plans deductible and coinsurance, if applicable. BCBSM approved facilities only.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

These services may require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: Cosmetic surgery, corrective eye surgery, investigational and experimental procedures.

Outpatient Rehabilitation Services

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Physical, occupational, chiropractic and osteopathic manipulative therapy limited to a combined maximum of 30 visits per member per calendar year. Speech therapy limited to a maximum of 30 visits per member per calendar year. Cardiac/pulmonary visits limited to a maximum of 30 visits per member per calendar year.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

These services may require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: Cosmetic surgery, corrective eye surgery, investigational and experimental procedures.

Radiation

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Prior authorization is required.

Exclusions: nan

Skilled Nursing Facility

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Limit: 45.0 Days per Year

BCBSM-participating facilities only. These services require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: Custodial care.

Substance Abuse Disorder Inpatient Services

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 20.00% Coinsurance after deductible

BCBSM approved facilities only. These services require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$30.00 Copay after deductible

Tier 1 in-network $30.00 Copay after deductible

Out-of-network 40.00% Coinsurance after deductible

Copayment applies to providers office and virtual visit by participating BCBSM provider and virtual care visit from BCBSM selected vendor app only. Additional services are subject to the plans deductible and coinsurance, if applicable. BCBSM approved facilities only.

Exclusions: nan

Transplant

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

BCBSM designated facilities only. Subject to BCBSM medical criteria.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

0.00%

Tier 1 in-network 0.00%

Out-of-network 40.00% Coinsurance after deductible

Cost sharing does not apply for preventive services. Depending on the type of services, a copayment, coinsurance or deductible may apply.

Exclusions: nan

Routine Eye Exam for Children

No Charge

Tier 1 in-network No Charge

Out-of-network No Charge

Limit: 1.0 Exam(s) per Year

A child is defined as a member up to the age of 19. Out of network is paid up to the allowed amount.

Exclusions: nan

Well Baby Visits and Care

0.00%

Tier 1 in-network 0.00%

Out-of-network 40.00% Coinsurance after deductible

Quantity limits based on PPACA.

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$15.00 Copay after deductible

Tier 1 in-network $15.00 Copay after deductible

Out-of-network 100.00%

Prior authorization, step therapy and quantity limits may apply to select drugs. The penalty for not having prior authorization is denial of payment. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumers deductible, cost-sharing or out of pocket maximum. For out-of-network providers, member must pay the full cost of the drug and submit to BCBSM for reimbursement.

Exclusions: Quantity limits per fill may apply for 30-day retail, 90-day retail and up to 90 day mail order. Opioid-containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply.

Non-Preferred Brand Drugs

$150.00 Copay after deductible

Tier 1 in-network $150.00 Copay after deductible

Out-of-network 100.00%

Non Preferred Specialty Drugs

45.00% Coinsurance after deductible

Tier 1 in-network 45.00% Coinsurance after deductible

Out-of-network 100.00%

BCBSM has contracted with an exclusive pharmacy network for specialty drugs. Call the customer service phone number on the back of your ID card for the pharmacys phone number or location nearest to you. If you obtain your specialty drugs from any other pharmacy, you are responsible for the total cost. Prior authorization, step therapy and quantity limits may apply to select drugs. The penalty for not having prior authorization is denial of payment. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumers deductible, cost-sharing or out of pocket maximum.

Exclusions: Specialty drugs are limited to a 30-day supply per fill, however some may be limited to a 15-day supply fill, depending on the medication.

Preferred Brand Drugs

$100.00 Copay after deductible

Tier 1 in-network $100.00 Copay after deductible

Out-of-network 100.00%

Specialty Drugs

40.00% Coinsurance after deductible

Tier 1 in-network 40.00% Coinsurance after deductible

Out-of-network 100.00%

Exclusions: Specialty drugs are limited to a 30-day supply per fill, however some may be limited to a 15-day supply fill, depending on the medication.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 20.00% Coinsurance after deductible

Accidental injury and emergency only.

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

BCBSM approved providers only.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

0.00%

Tier 1 in-network 0.00%

Out-of-network 40.00% Coinsurance after deductible

Limit: 26.0 Visit(s) per Year

Dietician Services.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

50.00% Coinsurance after deductible

Tier 1 in-network 50.00% Coinsurance after deductible

Out-of-network 70.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

0.00%

Tier 1 in-network 0.00%

Out-of-network 40.00% Coinsurance after deductible

Morbid obesity weight management and nutritional counseling.

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Bariatric Surgery

50.00% Coinsurance after deductible

Tier 1 in-network 50.00% Coinsurance after deductible

Out-of-network 70.00% Coinsurance after deductible

Limit: 1.0 Procedure(s) per Lifetime

Subject to BCBSM medical criteria.

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge

Tier 1 in-network No Charge

Out-of-network No Charge

Limit: 1.0 Item(s) per Year

A child is defined as a member up to the age of 19. Out of network is paid up to the allowed amount.

Exclusions: nan

Gender Affirming Care

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

These services may require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: Cosmetic surgery, investigational and experimental procedures.

Habilitation Services

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Physical and occupational therapy limited to a combined maximum of 30 visits per member per calendar year. Speech therapy limited to a maximum of 30 visits per member per calendar year.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Prior authorization is required. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Infertility Treatment

50.00% Coinsurance after deductible

Tier 1 in-network 50.00% Coinsurance after deductible

Out-of-network 70.00% Coinsurance after deductible

Underlying causes only. These services require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: In vitro fertilization and artificial insemination.

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

20.00% Coinsurance after deductible

Tier 1 in-network 20.00% Coinsurance after deductible

Out-of-network 40.00% Coinsurance after deductible

Medically necessary only.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

50.00% Coinsurance after deductible

Tier 1 in-network 50.00% Coinsurance after deductible

Out-of-network 70.00% Coinsurance after deductible

Coverage includes medical care or services to treat dysfunction or TMJ resulting from a medical cause or Injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental x-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.

Exclusions: nan

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Silver Off Exchange Plan

HIOS Product ID

15560MI035

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

15560MI0350003-00

Plan Marketing Name

Blue Cross® Premier PPO Silver

Plan Variant Marketing Name

Blue Cross® Premier PPO Silver

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

70.01%

Issuer ID

15560

Issuer Marketplace Marketing Name

Blue Cross Blue Shield of Michigan Mutual Insurance Company

Market Coverage

Individual

Multiple In Network Tiers

National Network

Yes

Network ID

MIN006

Out of Country Coverage

Yes

Out of Country Coverage Description

Accidental injury and emergency only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Coverage outside the state of Michigan is out of network except for eligible urgent, emergency and accidental injuries services

Service Area ID

MIS006

State Code

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.70136785944842

Begin Primary Care Deductible Coinsurance After Number Of Copays

Inpatient Copayment Maximum Days

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$1,900

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$3,000

SBC Scenario, Having Diabetes, Coinsurance

$80

SBC Scenario, Having Diabetes, Copayment

$300

SBC Scenario, Having Diabetes, Deductible

$3,000

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

SBC Scenario, Treatment of a Simple Fracture, Copayment

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,800

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$18000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$9000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$9,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$36000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$18000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$18,000

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MIF252

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

Dental Only Plan

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-08-14 20:01:41

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

New/Existing Plan

Existing

Notice Required for Pregnancy

Is a Referral Required for Specialist?

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

PPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

15560MI0350003

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$6000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$3000 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$3,000

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$12000 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$6000 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$6,000

Unique Plan Design

Yes

Wellness Program Offered

Drug tier	Pharmacy type	Copay amount	Copay option	Coinsurance rate	Coinsurance option	Mail order

How do I choose the right ACA plan in Michigan?

Blue Cross® Premier PPO Silver (15560MI0350003) is a Silver PPO from Blue Cross Blue Shield of Michigan in Michigan for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Blue Cross® Premier PPO Silver support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Blue Cross® Premier PPO Silver HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Blue Cross® Premier PPO Silver support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Blue Cross® Premier PPO Silver?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for Blue Cross® Premier PPO Silver?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Accidental injury and emergency only

Does Blue Cross® Premier PPO Silver cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Coverage outside the state of Michigan is out of network except for eligible urgent, emergency and accidental injuries services

How do I enroll in or manage payments for Blue Cross® Premier PPO Silver?

Use the issuer portal https://paymentgateway.bcbsm.com/gateway/cmsinbound.do to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.

Blue Cross® Premier PPO Silver · 15560MI0350003

Key premiums & cost sharing

Stay on top of 2025 ACA deadlines

Open Enrollment window

Special Enrollment Periods

CSR & subsidy reminders

Thinking about switching?

How this plan handles key care scenarios

Plan identifiers & filings

Provider access snapshot

Provider network(s)

4,789 drugs tracked

What stands out for members

Covered services & limitations

Blue Cross® Premier PPO Silver · Variant 15560MI0350003-00

Pharmacy cost sharing by tier

Frequently asked questions

How do I choose the right ACA plan in Michigan?

Does Blue Cross® Premier PPO Silver support telehealth or virtual urgent care?

Is Blue Cross® Premier PPO Silver HSA-eligible and does it include dental or vision coverage?

Does Blue Cross® Premier PPO Silver support mail-order prescriptions?

Which disease management programs come with Blue Cross® Premier PPO Silver?

Is there out-of-country coverage for Blue Cross® Premier PPO Silver?

Does Blue Cross® Premier PPO Silver cover care outside the service area?

How do I enroll in or manage payments for Blue Cross® Premier PPO Silver?

Blue Cross® Premier PPO Silver · 15560MI0350003

Key premiums & cost sharing

Stay on top of 2025 ACA deadlines

Open Enrollment window

Special Enrollment Periods

CSR & subsidy reminders

Thinking about switching?

How this plan handles key care scenarios

Similar 2025 ACA plans

Blue Cross® Premier PPO Value

Blue Cross® Premier PPO Bronze HSA

Blue Cross® Premier PPO Gold

Plan identifiers & filings

Provider access snapshot

Provider network(s)

4,789 drugs tracked

What stands out for members

Covered services & limitations

Blue Cross® Premier PPO Silver · Variant 15560MI0350003-00

Pharmacy cost sharing by tier

Frequently asked questions

How do I choose the right ACA plan in Michigan?

Does Blue Cross® Premier PPO Silver support telehealth or virtual urgent care?

Is Blue Cross® Premier PPO Silver HSA-eligible and does it include dental or vision coverage?

Does Blue Cross® Premier PPO Silver support mail-order prescriptions?

Which disease management programs come with Blue Cross® Premier PPO Silver?

Is there out-of-country coverage for Blue Cross® Premier PPO Silver?

Does Blue Cross® Premier PPO Silver cover care outside the service area?

How do I enroll in or manage payments for Blue Cross® Premier PPO Silver?