Benefit Eligibility
All regular, full-time employees who have met the required waiting periods are benefit-eligible.
Dependent Eligibility
Dependents eligible for coverage include:
- Employee’s legal spouse
- Employee’s dependent children, including those related by birth, marriage, legal adoption, or legal guardianship
Dependent children are eligible for coverage under the following conditions:
- Medical coverage: Until the end of the month in which they turn 26.
- Dental and Vision coverage: Until the end of the year in which they turn 19, unless the child is a full-time student, in which case they remain eligible until the end of the year in which they turn 23.
Benefit Enrollment
Employees can enroll or make changes to their benefit elections in the following circumstances:
- Within 31 days of the date of hire (for newly hired employees).
- During the annual benefits open enrollment period (typically held in mid-October).
- Within 31 days of experiencing a qualifying life event
To complete benefit elections or make changes, employees should use the Employee Navigator benefits enrollment software. This platform allows employees to view available benefits, make selections, and update personal information during open enrollment or after a qualifying life event.
Qualifying Life Events
Employees have 31 days from the date of a qualifying event to notify Human Resources and/or request changes to their benefits via Employee Navigator. Evidence of the event is required, and the change in coverage must be consistent with the change in status. Examples of qualifying events include:
- Change in legal marital status (e.g., marriage, divorce, or legal separation).
- Change in the number of dependents (e.g., birth, adoption, or a dependent child no longer qualifies).
- Change in spouse’s employment status, resulting in a loss or gain of coverage.
- Entitlement to Medicare or Medicaid.
Medical Insurance
Your medical benefits offer comprehensive coverage for both planned and emergency care, providing you with flexibility to choose the plan that best fits your needs. While all plans cover the same types of medical services, they differ in how costs are shared between you and the plan, including employee contribution rates and out-of-pocket expenses.
When selecting a plan, consider factors such as how often you visit the doctor, whether you require out-of-network coverage, and your preference for balancing employee contribution rates with your out-of-pocket costs for medical services.
The WCRC provides two medical plan options through Blue Cross Blue Shield (BCBS): PPO 4 and PPO 7.
Plan Comparison
| Plan Feature | PPO 4 | PPO 7 |
| Deductible | $500 Individual/$1,000 Family | $500 Individual/$1,000 Family |
| Annual Coinsurance Maximums | $1,500 Individual/$3,000 Family | $1,000 Individual/$2,000 Family |
| Annual Out-of-Pocket Maximums | $6,350 Individual/$12,700 Family | $6,350 Individual/$12,700 Family |
| Coinsurance Amounts | 20% of approved amount for mental health care and substance abuse treatment
20% of approved amount for most other covered services |
10% of approved amount for mental health care and substance abuse treatment
10% of approved amount for most other covered services |
| Office Visit Copay | $20 Copay | $20 Copay |
| Emergency Room Copay | $100 Copay | $100 Copay |
| Online Doctor Visit Copay | $5 Copay | $5 Copay |
Deductible Copay Example PPO 4
Deductible Copay Example PPO 7
Coordination of Benefits
Coordination of Benefits (COB) is how health care carriers coordinated benefits when members or their dependents are covered by more than one health care plan. Under COB, carriers work together to make sure members receive the maximum benefits available under their health plan. If an employee or any of their dependents have more than one health insurance plan it is their responsibility to notify BCBS and to complete the Coordination of Benefits Form.
Medical Buy-Out
Employees who have medical coverage elsewhere can waive WCRC’s medical insurance and receive a buy-out of up to $3,000 per year. Proof of other coverage is required to qualify for the buy-out. Employees and their eligible dependents will still have access to flexible spending accounts, dental insurance, and vision insurance.
Blue 365
As a member of BCBS, employees get exclusive discounts on healthy products and services through Blue365. Log into your account at bcbsm.com to browse and redeem the discounts. Here’s some of the discounts offered:
- Deals on products and services such as hearing aids, fitness gear and nutrition resources
- Access to $25 per month gym memberships through Healthways Fitness Your Way. There are more than 9,500 participating gyms including L.A. Fitness and Snap Fitness
- Discounts on LASIK and eye care services
Virtual Care
WCRC’s medical plans include Virtual Care by Teladoc Health®, offering 24/7 remote access to U.S. board-certified doctors, psychiatrists, and licensed therapists through your smartphone, tablet, or computer. This service provides convenient care for both physical and mental health needs.
Medical Care
- Ideal for minor illnesses such as colds, sore throats, urinary tract infections, and pink eye when your primary care provider isn’t available.
- No appointment is needed, with an average wait time of 10 minutes or less.
- Costs are comparable to or lower than in-person office visits.
Mental Health Care
- Appointments are required for mental health services, with evening and weekend availability.
- For urgent mental health needs, additional options are available through your Blue Cross Blue Shield of Michigan or Blue Care Network plan.
How to Access
- Download the Teladoc Health® app on your smartphone or tablet.
- Log in via your computer at https://www.bcbsm.com/find-care/virtual-care/www.bcbsmonlinevisits.com.
- Follow the prompts to set up your account and connect with a healthcare professional.
BCBS Mobile App
The BCBS mobile app is available to make it easier to manage your medical benefits. You can access information such as the status of your deductible and out-of-pocket maximum, view claims and show your medical ID card to providers. You can also get answers fast to questions about your
plan with the 24/7 support of MIBlue Virtual Assistant.
Transparency in Coverage
According to the Federal Government’s Transparency in Coverage rule, plans and issuers must make public machine-readable files containing certain pricing information. These machine-readable files include negotiated rates for in-network providers and allowed amounts and historical billed charges for out-of-network providers.
https://bcbsm.sapphiremrfhub.com/tocs/current/washtenaw_county_road_commission.
Conditions Management Programs
Managing your health is easier with support. WCRC’s medical plans include condition management programs through Blue Cross Blue Shield of Michigan and Blue Care Network, in partnership with Teladoc Health®, at no extra cost. These programs provide personalized tools and expert coaching to help you manage chronic conditions and improve your overall health.
Program Highlights
- Diabetes Management: Advanced glucose meter, unlimited test strips, 24/7 support, and personalized coaching.
- Diabetes Prevention: Smart scale, nutrition guidance, and meal planning support.
- Hypertension: Blood pressure monitor, digital reports, and goal-based action plans.
- Weight Management: Smart scale, one-on-one coaching, and habit-building guidance.
All resources are accessible in one convenient place via the Teladoc Health® app.
Get started today to take control of your health while reducing care costs!
Conditions Management FAQ
Condition Management Programs Flyer
RELATED DOCUMENTS
BCBS Benefit Guide
Benefits-at-a-Glance PPO 4
Benefits-at-a-Glance PPO 7
Online Account Registration
Summary of Benefits and Coverage PPO 4
Summary of Benefits and Coverage PPO 7
Understanding Language of Health Care
BCBS Surprise Billing Model Notice
BCBS Free Nurse Line
Care Options
Prescription Drug Coverage
All WCRC medical plans include prescription drug coverage through BCBS, available via mail-order service and nationwide retail pharmacy.
Summary of Coverage
| 90-Day Retail Network Pharmacy | *In-Network Mail Order Provider | In-Network Pharmacy (not part of the 90-day retail network) | Out-of-Network Pharmacy | ||
| Generic Prescription Drugs | 1 to 30-day period | $0 Copay | $0 Copay | $0 Copay | 25% prescription drug out-of-network retail pharmacy provider |
| 31 to 83-day period | No Coverage | $0 Copay | No Coverage | No Coverage | |
| 84 to 90-day period | $0 Copay | $0 Copay | No Coverage | No Coverage | |
| Brand Name Prescription Drugs | 1 to 30-day period | $30 Copay | $30 Copay | $30 Copay | $30 copay plus an additional 25% prescription drug out-of-network retail pharmacy provider |
| 31 to 83-day period | No Coverage | $30 Copay | No Coverage | No Coverage | |
| 84 to 90-day period | $30 Copay | $30 Copay | No Coverage | No Coverage |
Lifestyle Drugs
Lifestyle drugs are excluded from the prescription drug plan. Lifestyle drugs are health habit and reproductive drugs such as those that treat sexual impotency or infertility, help in weight loss or help to stop smoking. They are not designed to treat acute or chronic illnesses or be prescribed for medical conditions that have no demonstrable physical harm if not treated.
Prior Authorization/Step Therapy
BCBS requires review of certain drugs before the plan will cover them, which is called prior authorization. BCBS will review the member’s medication history to determine whether they’ve tried a preferred alternative first, which is known as step therapy. Step therapy requires members to try less expensive options before “stepping up” to drugs that cost more. Prior authorization and step therapy ensure that medically sound and cost-effective medications are prescribed appropriately. A complete list of medications that require prior authorization or step therapy can be found at bcbsm.com/pharmacy.
Mail Order
Save money and time with fewer refills when you get a 90-day supply of the medication you take regularly. Please note that not all medications are available in a 90-day supply. Here’s how to find out if your prescription is eligible:
- Log in to your account at bcbsm.com
- Hover over My Coverage in the blue bar at the top of the page
- Select Prescription Drugs from the drop down
- Click the link, Price a drug and view additional benefit requirements. It will take you directly to Express Scripts®. You won’t have to log in again
- Enter the name of the drug and follow the instructions. You’ll need to know the dosage and how often you’ll be taking it
- You’ll get an alert if your medication has a quantity limit
Dental Insurance
Dental insurance provides coverage for many dental services that you and your eligible dependents may need. The plan offers both network or out-of-network coverage.
WCRC provides dental benefits through Delta Dental. Delta Dental provides national network coverage through two networks: Delta Dental PPO and Delta Premier. You receive greater benefit coverage when you use a provider who participates in the Delta Dental PPO network.
Summary of Coverage
| Plan Feature | Base | Enhanced |
| Deductible | $25 Individual/$75 Family | $25 Individual/$75 Family |
| Maximum Benefit Amount
(Class A, B and C Services) |
$1,000 (per calendar year, per person) | $2,000 (per calendar year, per person) |
| Maximum Benefit Amount
(Class D Services – Orthodontia) |
$1,000 (lifetime maximum, per person) | $2,000 (lifetime maximum, per person) |
| Dental Percentage Payable | Class A Services (Preventative) – 100%
Class B Services (Basic) – 100% Class C Services (Major) – 50% Class D Services (Orthodontia) – 50% |
Class A Services (Preventative) – 100%
Class B Services (Basic) – 100% Class C Services (Major) – 50% Class D Services (Orthodontia) – 50% |
Delta Dental App
The Delta Dental Mobile App helps you get the most out of your dental benefits anytime, anywhere. Use the dentist search or toothbrush timer without logging in, or enter your username and password to securely access your personal benefit information or estimate your dental care costs. Delta Dental’s free app is optimized for iOS (Apple) and Android devices. To download our app on your device, visit the App Store (Apple) or Google Play (Android) and search for Delta Dental.
Vision Insurance
Vision insurance provides coverage for many vision care services that employees and their eligible dependents may need.
WCRC provides vision benefits through VSP. The plan offers both network and out-of-network coverage.
Summary of Coverage
| Plan Feature | Base | Enhanced |
| Vision Exam | $10 | $0 |
| Prescription Glasses (lenses and/or frames) | $20 | $0 |
| Contacts | $20 | $0 |
| Materials Allowance* | $140 | $200 |
| Frequency | Exams: 12 months Lenses: 12 months Frames: 24 months |
Exams: 12 months Lenses: 12 months Frames: 12 months |
| Extra Savings | ||
|
||
| *The materials allowance applied to the entire purchase of eyeglasses (lenses and frames) or contacts in lieu of eyeglasses. | ||
HELPFUL LINKS
RELATED DOCUMENTS
Benefits-at-a-Glance – Enhanced
Benefits-at-a-Glance – Base
EyeconicBlue Vision PowerPoint
COBRA
The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) gives employees and their qualified beneficiaries the opportunity to continue benefit coverage under the employer’s medical plan, dental plan, vision plan and flexible spending accounts when a “qualifying event” would normally result in the loss of eligibility.
Length of Coverage
Coverage may continue for differing lengths of time depending upon the reason for eligibility. The time limitations are:
- Up to 18 months if loss of coverage is due to termination of employment or reduction in work hours
- Up to 36 months for dependents if loss of coverage is due to death, divorce, or a dependent child’s loss of eligibility
- Up to 29 months if the individual is disabled at the time of eligibility for continued coverage or is disabled within 60 days of eligibility for continued coverage
COBRA Rates
| PPO-4 | PPO-7 | Dental | Vision | |
| Single | $529.19 | $543.37 | $38.34 | $3.74 |
| 2-person | $1,270.04 | $1,304.09 | $92.02 | $9.00 |
| Family | $1,587.56 | $1,630.11 | $115.03 | $11.25 |
Employee Resonsibility
WCRC makes every effort to comply with the guidelines regarding an employee’s and qualified dependent’s rights under COBRA. Under certain circumstances such as divorce and dependent eligibility, it is the employee’s responsibility to advise the Human Resources Department so the extended coverage may be offered to the employee’s dependents.
Related Documents
Employee Assistance Program
We all experience times when we need a little help managing our personal lives. WCRC understands this and is providing the Employee Assistance Program (EAP) to covered employees in connection with your group insurance from The Standard, to offer support, guidance and resources to help you and your family find the right balance between your work and home life.
What Can the EAP Do for Me?
Experienced master’s-degreed clinicians will confidentially consult with you over the telephone and direct you to the solutions and resources you need. You may also receive referrals to support groups, community resources, a network counselor or your health plan. These services are available for covered employees, their dependents, including children to age 26, and all household members.
What Services does the EAP Offer?
- Child care and elder care
- Alcohol and drug abuse
- Life improvement
- Difficulties in relationships
- Stress and anxiety with work or family
- Depression
- Goal-setting
- Emotional well-being
- Financial and legal concerns
- Grief and loss
- Identity theft and fraud resolution
- Online will preparation
How do I Access the EAP?
Simply log on to https://www.healthadvocate.com/site/. In emergency situations, you may call the toll-free number to speak with a master’s-degreed clinician who can also connect you to emergency services.
Your program also includes up to three face-to-face assessment and consultative sessions per issue. A clinician will work with you to schedule appointments according to your needs.
Helpful Links
RELATED DOCUMENTS
EAP Employee Guide
EAP Service Overview
EAP Mobile App
Legal Services
