Insurance Plan Information | 2023
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
Summary Plan Description
Welfare Plan Self Insured- SPD
Welfare Plan Fully Insured – SPD
Cafeteria Plan – SPD
More Plan Information
Benefits Guide eBook
Annual Legal Notices
Affordable Care Act Market Place Coverage Options
ACA Market Place Notice
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
IMPORTANT NOTE:
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: 71505
Rx BIN: 610011
Rx Group: BCBSMAN
Medical Insurance Plan Information
Plan Information
Plan Summary and Payroll Deductions
Medical Forms
Claims Reimbursement Form
Claim Appeal Form
Basic Plan
Insurance Plan Documents
Summary of Benefits and Coverage
Uniformed Glossary of Health Coverage and Medical Terms
Benefits at a Glance
Rx – Prescription Drug Plan
How do I know if my plan covers my prescription drug?
Prescription Drug Mandatory Mail Program Info and Frequently Asked Questions
Prescription Plan Documents
Benefits at a Glance
Pharmacy Forms
Rx Drug Reimbursement Form
Contact Information
Members: 1-855-811-2223
Providers: 1-844-642-9087
Mandatory Mail
Provider Helper Memo
Optum Rx Home Delivery Form
Preventative Drug Lists (bcbsm.com/druglists)
Mandatory Mail Drug List
Preventative Drug Coverage (PDF)
Prior Authorization and Step Therapy Guidelines (PDF)
Quantity Limits (PDF)
Dental and Vision Plan Information
Dental Plan
Insurance Plan Documents
Benefits Summary and Payroll Deductions
Benefits at a Glance
Contact Information
1-888-826-8152
Dental Forms
Claims Reimbursement Form
Vision Plan
Insurance Plan Documents
Benefits Summary & Payroll Deductions
Benefits at a Glance
Visit Assistance Info Sheet (Give to Your Provider)
Contact Information
1-800-877-7195
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)
Forms
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
More Plan Information
Flexible Spending Account: Getting Started
Dependent Care Account: Getting Started
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.
Frequently Asked Questions
Employee Assistance Program
Don’t delay if you need help:
Phone Number: 1-800-316-2796
Website: mutualofomaha.com/eap
Services Provided by Mutual of Omaha
These consultations and resources are confidential.
Additional Information
Omada
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.
MORE GREAT NEWS:
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:
www.omadahealth.com/usui
Livongo
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.
The program is offered at no cost to members and covered dependents with diabetes and coverage offered through your employer’s sponsored Blue Cross Blue Shield of Michigan health plan.
Join today at join.livongo.com/BCBSM/register
or call (800) 945-4355 Use registration code: BCBSM
