Health Insurance

If you are eligible to participate in Health Insurance Benefits (>.67 FTE), you may select one of the College group health insurance plans with Blue Cross Blue Shield of Michigan OR you may waive your coverage to this benefit, effective 7/1/08.

To waive coverage, please complete the Health Insurance Waiver form.

To enroll in health insurance, please complete the BCBSM Enrollment Form. Prior to completing the form, you will want to review and select your health insurance plan option. Select carefully as the plan you select will be your coverage from July 1, 2008 - June 30, 2009. You will not have the option of switching plans again until July 1, 2009!

Selecting Health Plan

Currently there are two PPO (Preferred Provider Organizations) health plan options available. Both plans provide coverage for most preventative medical services at 100% and a $15/$25/$50 Rx Prescription Drug Coverage. Plans differ in the Health Insurance Employee Contributions*, as well as co-pays, deductibles and co-insurance coverage. In making your selection, please review BOTH summary plan details, and based upon your individual needs, select the plan with the employee contribution level that is best for you and your family!

The Blue Plan (100) (click on plan name for summary plan detail) requires a higher per-pay employee contribution in exchange for a "richer" plan that offers lower co-pays, deductibles and no co-insurance for most in-network services. The Orange Plan (200) offers a lower per-pay employee contribution and still provides great coverage with slightly higher co-pays, deductibles and a 10% co-insurance share (up to an out-of-pocket maximum of $1500 per individual/$3000 family).

*Employee contributions are deducted from your payroll check on a pre-tax basis semi-monthly, and are based on your current salary and plan selection.

Instructions for Completing Enrollment Form

1. Subscriber SSN: Please use your SSN and upon enrollment, BCBMS will assign you a contract number for plan use.
2. BCBSM Group-Suffix: The BCBSM Group is "46629". For Suffix, enter the corresponding Plan Number (noted in () above) of the plan you wish to enroll, or simply write BLUE or ORANGE at the top of the form.
3. Subscriber Information: Please complete all information requested.
4. Spouse and Dependent Information: Please complete all requested information for your spouse and dependents. If your dependent is over the age of 19, please include proof of their full-time student status (this is normally provided by the registrar's office of the college/university your dependent is attending).
5. BCN/POS-Primary Care Physician Section: You are not required to complete this section as it is not applicable to our plan.
6. Coordination of Benefits: If you, your spouse, or any of your dependents, are eligible for other health insurance coverage, please complete this section. If they are not, please indicate this by checking "no".
7. Signature: Please sign and date.

Hope College Human Resources may maintain some employee medical information and this Privacy Policy outlines the protection of your Protected Health Information at the College.

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