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: related by birth, marriage, legal adoption or legal guardianship. Dependent children are eligible for coverage until the end of the month in which they turn age 26 for medical and the end of the year in which they turn 19 for dental/vision, unless they are a full-time student, in which case they will be covered until the end of the year in which they turn 23
Benefit Enrollment
Employees can enroll or change benefit elections:
- Within 31 days of date of hire (as a newly hired employee)
- During annual benefits open enrollment period (usually mid-October)
- Within 31 days of experiencing a qualifying event
Qualifying Life Events
When one of the following events occurs, employees have 31 days from the date of the event to notify human resources and/or request changes to their coverage. Evidence of the event is required. The change in coverage must be consistent with the change in status. Below are examples of qualifying events:
- Change in legal marital status (marriage, divorce or legal separation)
- Change in the number of dependents (for example, through birth or adoption, or if a child is no longer an eligible dependent)
- Change in spouse’s employment status (resulting in a loss or gain of coverage)
- Entitlement to Medicare or Medicaid
Medical Insurance
Your medical benefits provide comprehensive coverage for planned and emergency care. Each plan’s provisions vary, so you have flexibility when deciding which option is right for you and your family. All of the medical plans provide coverage for the same types of medical services; however, the employee contribution rate for each plan varies based on how the plan pays for those services.
When selecting a plan, think about how frequently you visit the doctor, whether you need out-of-network coverage and how you want to balance your employee contribution rates with what you are required to pay for medical services
WCRC offers a PPO 4 and a PPO 7 medical plan through Blue Cross Blue Shields (BCBS).
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
2024 Employee Contributions (per pay)
| Tier | PPO 4 | PPO 7 |
| Single | $6.35 | $18.10 |
| 2-Person | $15.24 | $43.45 |
| Family | $19.05 | $54.31 |
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
If an employee and their dependents have medical coverage elsewhere, they can choose to waive medical insurance and receive a buy-out of $75 per pay period (up to $1,950 per year). Proof of coverage must be provided in order to receive the buy-out. Employees and eligible dependents will still be eligible to participate in the flexible spending accounts, dental 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
24/7 Online Health Care
WCRC medical plans include 24/7 online health care through Blue Cross Online Visits™. With online health care, you can see a U.S. board-certified doctor anytime, anywhere. No appointment needed. When your doctor is unavailable, you can either use a mobile device to log into the BCBSM Online Visits™ app, or a computer to log in to https://www.bcbsmonlinevisits.com/landing.htm.
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.
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 up to age 19) |
$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% |
2024 Employee Contributions (per pay)
| Tier | Base | Enhanced |
| Single | $3.05 | $3.86 |
| 2-Person | $7.31 | $9.26 |
| Family | $9.14 | $11.57 |
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. | ||
2024 Employee Contributions (per pay)
| Tier | Base | Enhanced |
| Single | $.31 | $.71 |
| 2-Person | $.62 | $1.42 |
| Family | $1.03 | $2.35 |
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
