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 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 Summary of Benefits Coverage (SBC) documents for quick reference about your health plan coverage or to easily compare your health plan options. The 2016 and 2017 SBCs are listed below.

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

2016 Summary of Benefits and Coverage

For faculty, staff, retirees and members of POAM, COAM, HOA, IUOE, LEO, Trades and AFSCME collective bargaining units:

For members of the Michigan Nurses Association (MNA):

2017 Summary of Benefits and Coverage

For faculty, staff, retirees and members of POAM, COAM, HOA, IUOE, LEO, Trades and AFSCME collective bargaining units:

For members of the Michigan Nurses Association (MNA):

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.

Claim Forms

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

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.

Plan Documents and Additional Resources

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