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.
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
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
600 E. Lafayette Blvd.
Detroit, MI 48226-2998
Customer Service: 1-888-605-2566
Benefits & Eligibility: 1-800-676-2583
Group Number: 71505
Rx BIN: 610011
Rx Group: BCBSMAN
Medical Insurance Plan Information
Plan Summary and Payroll Deductions
Rx – Prescription Drug Plan
Prescription Plan Documents
Benefits at a Glance
Rx Drug Reimbursement Form
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
Insurance Plan Documents
Benefits Summary & Payroll Deductions
Benefits at a Glance
Visit Assistance Info Sheet (Give to Your Provider)
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
Group ID: G000BGJ7
Plan Documents and Plan Descriptions
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
$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:
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
Up to $3,050.00 per year.
Dependent Daycare – DCA
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.
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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:
Diabetes Management, Simplified
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