Dependent Information for 2015 Tax Reporting
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 new 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 dependents covered by your University of Michigan health plan, please complete the Dependent Information Form and return 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 documents for quick reference about your health plan coverage or to easily compare your health plan options.
2016 Summary of Benefits and Coverage
- CMM Summary of Benefits and Coverage
- CMM Summary of Benefits and Coverage - MNA
- HAP Summary of Benefits and Coverage
- HAP Summary of Benefits and Coverage - MNA
- U-M Premier Care Summary of Benefits and Coverage
- U-M Premier Care Summary of Benefits and Coverage - MNA
- BCBSM Community Blue PPO Summary of Benefits and Coverage
- BCBSM Community Blue PPO Summary of Benefits and Coverage - MNA
- GradCare 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.
- Comprehensive Major Medical Provider Directory
- U-M Premier Care Provider Directory
- Community Blue PPO Provider Directory
- Health Alliance Plan HMO Provider Directory
- GradCare Provider Directory
Most enrollment and/or benefit changes are completed in Wolverine Access. However, certain changes may be completed by submitting a paper form.
- 2016 Benefits Enrollment Form
- Benefits Enrollment/Change Form
- Group Health Insurance Application for Special Enrollment (HIPAA)
- Certification of Other Medical Coverage
- Disabled Dependent Certification
- Application for Principally Supported Child
- Moving Out of a Managed Care Service Area
- Blue Cross Blue Shield Coordination of Benefits Form
Use these forms to submit a claim to your health plan.
- BCBSM Community Blue PPO Plan Claim Form (Domestic claims)
- BCBSM CMM Plan Claim Form (Domestic claims)
- BlueCard Worldwide International Claim Form (Foreign Claims)
- GradCare Member Reimbursement Form
- U-M Premier Care Member Reimbursement Form
Graduate Student Forms
These forms are for use by graduate students enrolled in GradCare.
- GradCare Off-Site Registration Form
- Benefits Enrollment Change Form (for benefit-eligible fellowship holders and medical students)
Retiree Forms and Documents
Information about your benefits in retirement.
These resources pertain to COBRA continuation of your benefits.
- Notice of COBRA Qualifying Event
- Notice of COBRA Second Qualifying Event
- COBRA Notification of Other Coverage, Medicare Entitlement, or Cessation of Disability
- Notice of Disability
Plan Documents and Additional Resources
These resources provide additional information about your U-M health plan options.
- Enrollment Deadlines
- Enrollment Guide
- 2016 Health Plan Coverage Comparison Chart
- 2017 Health Plan Coverage Comparison Chart
- In Vitro Fertilization Benefit
- Blue Cross Blue Shield of Michigan Member Handbook
- BCBSM Community Blue PPO Benefits-at-a-Glance
- MNA/Trades - BCBSM Community Blue PPO Benefits-at-a-Glance
- CMM Benefits-at-a-Glance (2015)
- GradCare Benefit Document
- GradCare Benefits-at-a-Glance
- GradCare Member Handbook
- Health Alliance Plan HMO Certificate of Coverage
- Health Alliance Plan HMO Riders
- U-M Premier Care Benefits-at-a-Glance
- U-M Premier Care Benefit Document
- U-M Premier Care Member Handbook
- U-M Premier Care Plan 65 Medicare Primary Members Benefits-at-a-Glance
- U-M Premier Care Plan 65 Complementary Medicare Amendment
- U-M Premier Care Plan 65 Member Handbook
- MNA and TRADES U-M Premier Care Benefits-at-a-Glance
- U-M Premier Care Union Member Handbook
- U-M Premier Care Union Plan 65 Member Handbook
- University of Michigan HIPAA Notice of Privacy Practices