Tiered networks

These networks have cost-sharing "tiers"

Tier 1: Tiered networks are set up to offer plan members savings when they go to Tier 1 providers.

Tier 2: Care received from Tier 2 providers requires greater member cost-sharing.

Tier 3:

  • PPO members have Tier 3, which are out-of-network benefits, at the highest cost-sharing.
  • HMO members have no out-of-network benefits/no Tier 3.

Provider responsibility

Help patients by referring them to providers within the Tier 1 network. Use Find a Doctor to see which providers are in your patients' networks.

Care that HMO members receive from outside their network will not be covered. Patients will be liable for the full cost, except in certain transplant situations and in instances where services are not available within their network.

Tiered network: West MI Partners (WMP)

Available to: Large and small employer groups, various plans

Identification: Member ID cards indicate "West MI Partners."

Counties:

  • Large and small groups: Allegan, Barry, Calhoun, Kalamazoo, Kent, Lake, Mason, Mecosta, Newaygo, Osceola, Ottawa, and Van Buren
  • Large groups only: Ionia, Montcalm, Muskegon, Oceana

Tier 1 in-network providers:

You can find Tier 1 providers in the Find a Doctor tool. In Search results, under the "In-network" column, they will show Tier 1. Tier 1 includes:

  • Hospitals: All Spectrum Health hospitals; Holland Hospital; Metro Health; Bronson Healthcare hospitals (Lakeview, Battle Creek, Kalamazoo)
  • Physicians: All physicians affiliated with Spectrum Health, Holland Hospital, Metro Health and Bronson Healthcare
  • Ancillary facilities: Tier 1 includes a broad selection of free-standing, lower-cost facilities.

Tier 2 in-network providers:

Tier 2 includes contracted providers beyond those in Tier 1. You can find them in the Find a Doctor tool. In Search results, under the "In-network" column, they will show Tier 2.

Tiered network: Spectrum Health Employer Group

Available to: Spectrum Health employees and dependents in seven West Michigan counties

Identification: Member ID cards indicate "Spectrum Health Employer Group"

Counties:

  • Allegan, Barry, Ionia, Kent, Montcalm, Muskegon, Ottawa

Tier 1 in-network providers:

You can find Tier 1 providers in the Find a Doctor tool. In Search results, under the "In-network" column, they will show Tier 1. Tier 1 includes:

  • Hospitals: All Spectrum Health hospitals; Holland Hospital; and owned surgery centers and free-standing campus locations that provide diagnostic services
  • Physicians: Spectrum Health Medical Group; Holland Physician Hospital Organization; Answer Health shareholders and affiliates; We Are For Children; Neonatal Associates; Pediatric Surgeons of West Michigan; and pathology, anesthesiology, radiology and emergency room physicians serving a Spectrum Health or Holland hospital
  • Ancillary facilities:
    • Acute rehabilitation facilities
    • Ambulance services
    • Chiropractors
    • Dialysis facilities
    • Durable medical equipment (DME)
    • Health departments
    • Home infusion
    • Prosthetics and orthotics

Tier 2 in-network providers:

Tier 2 includes contracted providers beyond those in Tier 1. You can find them in the Find a Doctor tool. In Search results, under the "In-network" column, they will show Tier 2.

Tiered network: Southeast Michigan Partners

Available to: Southeast Michigan employer groups six Michigan counties

Identification: Member ID cards indicate "Southeast MI Partners- tiered network"

Counties:

  • Oakland, Macomb, Wayne, Washtenaw, St. Clair and Livingston

Tier 1 in-network providers:

You can find Tier 1 providers in the Find a Doctor tool. In Search results, under the "In-network" column, they will show Tier 1. Tier 1 includes:

  • Hospitals: St. John, Providence Park, Ascension Crittenton, St. Joseph Mercy, St. Mary Mercy Livonia, Lake Huron Medical Center, and Michigan Medicine (University of Michigan and health centers) for non-primary care with referral only
  • Physicians: Lake Huron PHO, Oakland Southfield Physicians, Southeast Michigan Clinically Integrated Network, and St. John Providence Partners in Care
  • Ancillary facilities:
    • Acute rehabilitation facilities
    • Ambulance services
    • Chiropractors
    • Dialysis facilities
    • Durable medical equipment (DME)
    • Health departments
    • Home infusion
    • Optometry (if they're linked to a Tier 1 ophthalmology)
    • Prosthetics and orthotics

Tier 2 in-network providers:

Tier 2 includes contracted providers beyond those in Tier 1. You can find them in the Find a Doctor tool. In Search results, under the "In-network" column, they will show Tier 2.