Dependent Information for 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 Summary of Benefits Coverage (SBC) documents for quick reference about your health plan coverage or to easily compare your health plan options.
2019 Summary of Benefits and Coverage
- CMM 2019 Summary of Benefits and Coverage
- CMM 2019 Summary of Benefits and Coverage - MNA (For Members of the Michigan Nurses Association)
- U-M Premier Care 2019 Summary of Benefits and Coverage
- U-M Premier Care 2019 Summary of Benefits and Coverage - MNA (for members of the Michigan Nurses Association)
- BCBSM Community Blue PPO 2019 Summary of Benefits and Coverage
- BCBSM Community Blue PPO 2019 Summary of Benefits and Coverage - MNA (for members of the Michigan Nurses Association)
- GradCare 2019 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
- 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.
- Benefits Enrollment/Change Form
- 2019 Health Plan Salary for Banding
- 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
- 2019 Health Plan Coverage Comparison Chart
- In Vitro Fertilization Benefit
- BCBSM Community Blue PPO 2018 Benefits-at-a-Glance
- MNA BCBSM Community Blue PPO 2018 Benefits-at-a-Glance (for members of the Michigan Nurses Association)
- CMM 2018 Benefits-at-a-Glance
- U-M Premier Care 2018 Benefit Document
- U-M Premier Care 2018 Benefits-at-a-Glance
- U-M Premier Care Plan 65 Medicare Primary Members 2018 Benefits-at-a-Glance
- MNA U-M Premier Care 2018 Benefits-at-a-Glance (for members of the Michigan Nurses Association)
- GradCare 2018 Benefit Document
- GradCare 2018 Benefits-at-a-Glance
- University of Michigan HIPAA Notice of Privacy Practices