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FAQ

How Can I Register for the MiCare Plan?

MiCare’s Regular Open Enrollment Season on all Plan Options start on July 1 and end on July 31 of every year.
Any eligible individual who is not currently enrolled in the Plan may enroll during this period. For those members who are currently enrolled in the Plan, they could do the following during the open season:

  1. To add or delete their enrolled dependents;
  2. to change from one Plan Option to another or
  3. to cancel your enrollment with the Plan

To add, delete or change from one option to another, members are required to submit an amendment form. To cancel your enrollment, you need to fill up a cancellation form and submit to any MiCare office before the deadline.
New enrollment and changes made during open enrollment season will become effective October 1.

Who is Eligible to Enroll in the MiCare Plan?

The following individuals are eligible to enroll in the MiCare Plan:

  1. Full time employees of the participating organizations;
  2. Dependents of full-time employees of the participating organizations (employee’s immediate family including lawful spouse, natural and adopted children and grandchildren & dependent parents and parents-in-law;
  3. Household members who lives with an eligible employee and depends on that employee for support;
  4. Government or agency employees whose government or agency does not participate in the Plan and the employees pay 100% of the premiums for themselves, dependents and household members;
  5. Former employees who were previously covered under the Plan, their dependents and household members if they pay 100% of the premiums for themselves, their dependents and other household members.

What are the Different Plan Options?

MiCare has four (4) Options to choose from to suit the varying needs of our members. These are:

  1. BASIC HEALTH PLAN (BA) - This Plan allows members to access medical services from local affiliated healthcare providers. Basic Plan members may access services from off-island healthcare facilities if they are recommended by the medical referral committee from State Hospitals and approved by Micare Administrator.
  2. SUPPLEMENTAL RESIDENT PLAN (SR) - This Plan allows members to access medical services from local and off-island approved network providers. Individual member in SR Plan are also eligible for Basic Plan Benefits. Members who have SR Plan are allowed to access off-island providers in Hawaii, Guam and Philippines without recommendation from State Referral Hospital. The member has to pay $100 annual deductible and 10% co-payment and MiCare will pay 90% of total eligible costs.
  3. SUPPLEMENTAL NON-RESIDENT PLAN (SNR) - This Plan is offered only to members residing off-island whether they are full time student or permanent full time employee of the FSM National or State Government. SNR members are allowed to access approved and non-approved off-island healthcare facilities and pay $5.00 deductible per visit and 10% co-payment. The Plan will pay 90% after deductible of all eligible medical charges.
  4. NON-REFERRAL OPTION (NR) - This Plan allows members to access medical services from local affiliated healthcare providers but not an off-island referral.
  5. REGIONAL AND INTERNATIONAL RESIDENT WORKERS (RI)

What are the Annual Maximum Benefits?

The maximum benefits for enrolled members under Basic Plan, Supplemental Resident and Supplemental Non-Resident Plan is $50,0000 per fiscal year (October 1-September 30) . This includes cost of medical care and non-medical expenses such as airfare tickets, stipend, ground transportation and others.

What are the Different Type of Benefits?

The following are the different type of benefits that MiCare offers to members:

  1. Medical Care Benefits includes out-patient consultations, diagnostic procedures and tests, maternity care, routine physical examination, hospital in-patient care, doctor’s fee, short term physical therapy and others specified under Part 6.2.a of MiCare Regulations.
  2. Prescription Drug Benefits – The Plan covers prescription drug as set forth under Part 7.8 of MiCare Regulations. Member pays $2 deductible and 10% co-payment per prescription. For Chronic refill program enrollees, one year membership will be $200.
  3. Vision Care Benefits– member is entitled for one pair of eyeglasses, every two years not to exceed $150 in cost.
  4. Dental Care Benefits— covers dental consultation, cleaning, simple dental extraction, temporary and permanent fillings. A Basic Plan member is covered up to a maximum of $300 per fiscal year and $500 for Supplemental Plan members.
  5. Prosthetic Appliances Benefits– The Plan covers 50% of the total cost of corrective appliances and artificial aids such as implants, pacemaker, braces and hearing aids.
  6. Emergency Benefits– This benefits is offered to Basic Plan members traveling abroad for a period not to exceed 30 days with a maximum benefit of $2,500. Emergency care applies also to Supplemental Resident member who needs emergency care abroad where there is no approved off-island healthcare facility.