Individual Employee Application
For Businesses Applying or Currently Enrolled
Explore small business health coverage from HealthChoice. Discover affordable group health benefits & coverage options to meet your needs.
- NO DEDUCTIBLES
- MONTHLY PREMIUMS ONLY $270 PER EMPLOYEE
- OPTIONAL VISION AND DENTAL
Employee Eligibility Requirements
By submission of the Subscriber Application, I herby certify that, to the best of my knowledge, I qualify as a Subscriber under the terms of the Subscriber Certificate by meeting all the following criteria:
I am an employee of a qualified employer or a member of a qualified association and have an anticipated work future of more than five (5) months.
I am currently without health care benefits and not eligible, without regard to the availability of coverage, for Medicare, Medicaid or other employer sponsored health coverage.
I am currently working at least 20 hours per week. I agree to notify HealthChoice if my hours are reduced to less than 20 hours per week for any reason at any time after enrollment.
My employer has not offered or contributed to health care benefits of employees in the same or similar job classification in which I am employed in the 65 day period immediately preceding the effective date of the Group Operating Agreement between my employer and HealthChoice of Michigan.
I am a resident of the State of Michigan as defined in the Subscriber Certificate, and I have accurately listed the County of my residence.
THIS FORM MUST BE COMPLETED BY EACH EMPLOYEE OR EMPLOYER ON HIS/HER BEHALF
Plan Copays
All Preventative Services
No Co-Pay
Doctor Office Visit
$20
Specialist Office Visit
$30
Physical Therapy
$20
Urgent Care Centers
$25
Ambulance
$200
Emergency Room
$100
Hospital Stay
$200
Generic Prescription
$10
Brand Name Prescription
$20
More About Individual Coverage
The HealthChoice program is similar to an HMO. You choose a primary care physician (PCP) within the network for your care. If your PCP can't treat you, they will refer you to an in-network specialist.
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