Health Plan Forms and Documents

Dependent Information for Tax Reporting

Dependent Information Form

The Affordable Care Act requires large employers like the university to report Social Security numbers for individuals and their covered dependents on Form 1095, a tax form that reports information about health coverage. If you received a notice from the university because a Social Security number is not on file for one or more your dependents covered by your University of Michigan health plan, please complete the Dependent Information Form and return it as instructed on the form. 

IMPORTANT INFORMATION: Under the Affordable Care Act, health coverage is not affected and will not be canceled if you do not provide a covered dependent's Social Security number. If not provided after multiple requests, the university will report to the IRS using your dependent's date of birth.

Summary of Benefits and Coverage

Use these Summary of Benefits Coverage (SBC) documents for quick reference about your health plan coverage or to easily compare your health plan options. 

View the Uniform Glossary of Health Coverage and Medical Terms for help understanding the information included in the SBCs.

2023 Summary of Benefits and Coverage

Find a Participating Health Care Provider

Use these resources to find a physician or other health care provider that participates with your health plan.

Enrollment/Change Forms

Most enrollment and/or benefit changes are completed in Wolverine Access.  However, certain changes may be completed by submitting a paper form. Additional forms are available on the Benefit Plan Forms and Documents page.

Claim Forms

Use these forms to submit a claim to your health plan.

  1. Go to the Blue Cross Blue Shield Global website.
  2. Click to accept the terms and conditions.
  3. Enter the three letters of your "Enrollee ID" found on your Blue Cross Blue Shield member ID card, and then click Go.
  4. Select Claims on the menu bar.
  5. To file a Blue Cross Blue Shield Global Core eClaim online, log in with your username and password or register for access.​​

Graduate Student Forms

These forms are for use by graduate students enrolled in GradCare.

Retiree Forms and Documents

Information about your benefits in retirement.

COBRA Forms

These resources pertain to COBRA continuation of your benefits.

Health Plan Machine-readable Files

H.R. 2471, the Consolidated Appropriations Act, 2021 introduced new federal regulations for health care price transparency. It aims to assist consumers by increasing the availability and transparency of health care price information. The goal is for this transparency to enhance market competition and lower health care costs.

As a group health plan sponsor, U-M is required to post the following health care information monthly on a public website:

  • In-network provider rates for covered items and services
  • Out-of-network allowed amounts and billed charges for covered items and services, if 20 or more claims in the 90-day period are included in the file

Access Blue Cross Blue Shield of Michigan’s machine-readable files to download the table of contents that contains web addresses for the .Json format files with in-network negotiated rates and out-of-network allowed amounts and historical billed charges. You will need to copy the URLs in the table of contents and paste in your browser to download the machine-readable files.

Important Notes

  • The information contained in this machine-readable file may be difficult to access without certain technology.
  • These files may be large and require a computer that can download at least up to 1TB (terabyte) of data. Most modern hard drives store half of this amount of data. Based on your computer’s storage and hard drive, attempting to open or download large files may cause instabilities in Windows, cause performance issues resulting in downloads that could take hours, days or weeks depending on the file size and hard drive combination. For reference: 1TB = 243 high-definition streaming movies (average 2 hours per movie).
  • This mandate is a building block for future customer-facing mandates, including a Price Transparency Tool and an Advanced Explanation of Benefits.
  • The data in the files may not be useful for the average consumer. For example, facilities that are paid based on a percent of charge will not have a dollar amount representing the amount paid for a service.
  • The machine-readable files will be updated monthly to ensure accuracy of the data and reflect changes in pricing and regulatory requirements.

Physicians Health Plan machine-readable files provide negotiated rates for items and services with in-network providers and allowed amounts based on historical payments to out-of-network providers. Machine-readable files are in JSON format, as required by CMS. They may be extremely large (more than 100GB and up to 1TB) and will require a special application to open. 

Once federal regulations are finalized, it is expected that a third set of machine-readable files for negotiated rates and historical net prices for covered prescription drugs will be added.

Plan Documents and Additional Resources

These resources provide additional information about your U-M health plan options.

Other Health Plan Documents