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Insurance Plan Information | 2023

This site contains a summary in English of your plan rights and benefits under the Usui International Cafeteria Plan or Usui International Group Health & Welfare Benefit Plan. If you have difficulty understanding any part of this site, contact Mr. Kyle Shepherd, in human resources at the plan administrator’s office: Usui International Corporation, 88 Partnership Way, Sharonville, OH 45241. Office hours are from 9:00 A.M. to 5:00 P.M, Monday through Friday. You may also call the plan administrator’s office at 513-448-0410, Ext 5607 for assistance.

“यो पुस्तिकामा उसुइ इन्टरन्याशनल ग्रूप हेल्थ एण्डवेलफेयर बेनिफिट प्लान वा उसुइ इन्टरन्याशनल क्याफेटेरिया प्लान  (Usui International Group Health & Welfare Benefit Plan or Usui  International Cafeteria Plan) अन्तर्गत तपाईंको अधिकार तथा सुविधाहरूहरूबारे अङ्ग्रेजी भाषामा एउटा सारांश दिइएको छ। यदि तपाईंलाई यो पुस्तिकाको कुनैपनि भाग बुझ्न गाह्रो भएको छ भने, प्लान एडमिनिस्ट्रेटरको कार्यालयको मानव स्रोतका श्री काइले शेपर्ड (Kyle Shepherd) लाई सम्पर्क गर्नुहोस्: Usui International Corporation, 88 Partnership Way, Sharonville, OH 45241. कार्यालय समय सोमवार देखि शुक्रवार बिहान 9:00 बजे देखि बेलुका 5:00 बजे सम्म हुनेछ। तपाईंले सहायताका लागि प्लान एडमिनिस्ट्रेटरको कार्यालयको 513-448-0410, एक्सटेन्शन 5607 मा पनि कल गर्न सक्नुहुन्छ।”

Ang site na ito ay naglalaman ng buod sa Ingles ng mga karapatan at benepisyo sa plano mo sa ilaim ng Usui International Cafeteria Plan or Usui International Group Health & Welfare Benefit Plan. Kung nahihirapan kang maunawaan ang alinmang bahagi ng site na ito, kontakin si Mr. Kyle Shepherd, sa human resources sa tanggapan ng administrador ng plan: Usui International Corporation, 88 Partnership Way, Sharonville, OH 45241. Ang oras ng opisina ay mula 9:00 A.M. hanggang 5:00 P.M, Lunes hanggang Biyernes. Maaari mo ring tawagan ang opisina ng administrador ng plan sa 513-448-0410, Ext 5607 para sa tulong.

Find a Doctor
Click here to locate a doctor or to see if your doctor works with Blue Cross Blue Shield of Michigan.

Blue Cross Online Visits
Feeling to bad to get out of the house? Try Blue Cross Online Visits and talk to a doctor over the internet from the comfort of your home. There is NO co-pay to use this service on our plans.

Michigan Planners
Need help with a claim. Having trouble understanding your bill. Contact Michigan Planners for assistance.
586-263-9000 or 800-674-9235

General Benefit Plan Information

Summary of Material Modifications
Explanation of specific changes to your benefits under the UIC Health Plans

Insurance Coverage Change Notices
Notices of benefit changes issued during the plan year.

Welfare Plan Documents

Benefit Plan Documents
Welfare Plan Self Funded – Full
Cafeteria Plan – Full
Welfare Plan Wrap Document – Full

Other Information
Certificate(s) of Creditable coverage may be requested in writing or in person from Human Resources. It may take up to 7-10 days for delivery.

Usui BCBSM Plan Reimbursement Amounts for all Covered Services to In-network Providers

File contains nearly 1TB terabyte of data and may be difficult to view on some computers.
Please proceed with caution.
Plan Reimbursement Data File

Medical, Dental and Vision Plans

All Medical, Dental and Vision products are offered through:
Blue Cross Blue Shield of Michigan

Contact Information
600 E. Lafayette Blvd.
Detroit, MI 48226-2998
Customer Service: 1-888-605-2566
Benefits & Eligibility: 1-800-676-2583
Precertification: 1-800-572-3413

Plan Information
Group Number:
Rx BIN: 610011

Medical Insurance Plan Information

Rx – Prescription Drug Plan

Dental and Vision Plan Information

Dental Plan

Insurance Plan Documents
Benefits Summary and Payroll Deductions
Benefits at a Glance
Contact Information
Dental Forms
Claims Reimbursement Form

Vision Plan

Vision Forms
Claims Reimbursement Form
Call VSP Member Services at 800.877.7195
Your Member ID for VSP is on Your Benefits card without the “UIL”

Life, AD&D and Voluntary Life Insurance​

All Life and Disability products are offer through:
Mutual of Omaha Insurance Company

Plan Information
Group ID: G000BGJ7

Plan Documents and Plan Descriptions

Life Insurance Plans
Benefits Summary

Disability Plans
Benefits Summary

Voluntary Life Insurance

$20,000 – $300,000 of additional coverage available at discounted rates*
Guarantee issue of $100,000 for employee at enrollment, if elected

Life/AD&D Policy

$20,000 of coverage provided at no cost to every UIC employee

Short Term Disability

Up to 13 weeks of pay at 60% of your normal weekly pay after illness* or injury

Long Term Disability

Additional coverage beyond 13 weeks at 60% of your normal weekly pay until you are able to return from illness or injury

Pricing   (Premium rates for Voluntary Life Insurance are payroll deducted once per month on the first pay of each month)
Evidence of Insurability (EOI) Online Form
Life Claim Form (Please see HR for Information)

Flexible Spending Accounts

All Flexible Spending Account products are offer through:
HSA Bank
Click Here to Access the HSA Bank Employee Website

Benefits Plan Documents

For more details and information, see the Cafeteria Plan SPD (Summary Plan Description) above

Medical – FSA

Deduction Limits
Up to $3,050.00 per year.

Dependent Daycare – DCA

Deduction Limits
Up to $5000.00 per year if single or married filing jointly or $2500.00 per year if married filing separate.

Employee Assistance Program

Don’t delay if you need help:
Phone Number: 1-800-316-2796

Services Provided by Mutual of Omaha
These consultations and resources are confidential.
Additional Information


Join Omada® to build healthy habits that last
Additional Information

Omada is a digital lifestyle change program. We combine the latest technology with ongoing support so you can make the changes that matter most – whether that’s around eating, activity, sleep, or stress. It’s an approach shown to help you lose weight and reduce the risks of type 2 diabetes and heart disease.

• Eat healthier
Learn the fundamentals of making smart food choices.
• Increase activity
Discover easy ways to move more and boost your energy.
• Overcome challenges
Gain skills that allow you to break barriers to change.
• Strengthen habits
Zero in on what works for you, and find lasting motivation.
• Stay healthy for life
Continue to set and reach your goals with strategies and support.

You’ll receive the program at no additional cost—a $650 value—if you or your adult dependents are enrolled in the company medical plan offered through Blue Cross Blue Shield of Michigan and are at risk for type 2 diabetes or heart disease.

Take a 1-minute health test to see if you’re eligible:


Diabetes Management, Simplified
Additional Information

A simple, advanced blood glucose meter, and as many strips and lancets as you need, 100% paid for by your employer.
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or call (800) 945-4355 Use registration code: BCBSM

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