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.

2022 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.


These resources pertain to COBRA continuation of your benefits.

Plan Documents and Additional Resources

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

Other Health Plan Documents