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Medical Insurance

Blue Cross Blue Shield Michigan (BCBSM)

PPO1_Change_Form.pdftrue1435682128435nelsontdPPO1 Change FormPPO1 Change Form/www.udmercy.edu/hr/benefits/medical/bcbs_pdf/PPO1_Change_Form.pdfnelsontd1422636553854nelsontd14226365993791077650PPO1_Enrollment_Form.pdftrue1435682128435nelsontdPPO1 Enrollment FormPPO1 Enrollment Form/www.udmercy.edu/hr/benefits/medical/bcbs_pdf/PPO1_Enrollment_Form.pdfnelsontd1422636746435nelsontd14226367793811128589BCBSM_PPO_1_OVERVIEW_2011.pdftrue1435682128435nelsontdPPO1 Benefits Overview PPO1 Benefits Overview /www.udmercy.edu/hr/benefits/medical/bcbs_pdf/BCBSM_PPO_1_OVERVIEW_2011.pdfpalmersc1308235916245palmersc1380031847440336721BCBSM_PPO1_Summary_of_Benefits_and_Coverage.pdftrue1435682128435nelsontdPPO1 Summary of Benefit CoveragePPO1 Summary of Benefit Coverage/www.udmercy.edu/hr/benefits/medical/bcbs_pdf/BCBSM_PPO1_Summary_of_Benefits_and_Coverage.pdfpalmersc1380031898919palmersc1380031898919371530/www.udmercy.edu/hr/benefits/medical/bcbs_pdf/formsforms

PPO3_Change_Form.pdftrue1435682128435nelsontdPPO3 Change FormPPO3 Change Form/www.udmercy.edu/hr/benefits/medical/bcbs_pdf_2/PPO3_Change_Form.pdfnelsontd1422636926775nelsontd14226369267751099955PPO3_Enrollment_Form.pdftrue1435682128435nelsontdPPO3 Enrollment FormPPO3 Enrollment Form/www.udmercy.edu/hr/benefits/medical/bcbs_pdf_2/PPO3_Enrollment_Form.pdfnelsontd1422636879074nelsontd14226368790741110339BCBSM_PPO_3_OVERVIEW_2011.pdftrue1435682128435nelsontdPPO3 Benefits Overview PPO3 Benefits Overview /www.udmercy.edu/hr/benefits/medical/bcbs_pdf_2/BCBSM_PPO_3_OVERVIEW_2011.pdfpalmersc1380031258536palmersc1380031976521277210BCBSM_PPO3_Summary_of_Benefits_and_Coverage.pdftrue1435682128435nelsontdPPO3 Summary of Benefit CoveragePPO3 Summary of Benefit Coverage/www.udmercy.edu/hr/benefits/medical/bcbs_pdf_2/BCBSM_PPO3_Summary_of_Benefits_and_Coverage.pdfpalmersc1380032011866palmersc1380032011866372013/www.udmercy.edu/hr/benefits/medical/bcbs_pdf_2/formsforms

BCBSM__RX_Plan_2009-10.pdftrue1435682128435nelsontdBlue Preferred Rx Prescription Drug CoverageBlue Preferred Rx Prescription Drug Coverage/www.udmercy.edu/hr/benefits/medical/bcbs_pdf_3/BCBSM__RX_Plan_2009-10.pdfpalmersc1380031266716palmersc1380031266716434207bcbsm_mail_orderMail Order Prescription Drug Plan (link)Mail Order Prescription Drug Plan (link)/www.udmercy.edu/hr/benefits/medical/bcbs_pdf_3/bcbsm_mail_orderpalmersc1380031266684palmersc1380031545436http://www.bcbsm.com/member/prescription_drugs/mail_order.shtml/www.udmercy.edu/hr/benefits/medical/bcbs_pdf_3/formsforms

ASR Health Benefits

ASR_Summary_of_Benefits_Coverage.pdfSummary of Benefits Coverage/www.udmercy.edu/hr/benefits/medical/hap_asr_pdf/ASR_Summary_of_Benefits_Coverage.pdf174967ASR_HAP_PPO_Enrollment_Form.pdfASR/HAP (PPO) Enrollment form/www.udmercy.edu/hr/benefits/medical/hap_asr_pdf/ASR_HAP_PPO_Enrollment_Form.pdf111308HAP-ASR_SBC.pdfBenefits Overview/www.udmercy.edu/hr/benefits/medical/hap_asr_pdf/HAP-ASR_SBC.pdf59586/www.udmercy.edu/hr/benefits/medical/hap_asr_pdf/formsforms

Health Alliance Plan of Michigan - HMO

(No longer available as of July 1, 2015)

HAP ENROLLMENT FORM.pdfEnrollment FormEnrollment Form/www.udmercy.edu/hr/benefits/medical/hap_pdf/HAP ENROLLMENT FORM.pdf228324HAP Membership and Record Change Form.pdfMembership and Record Change FormMembership and Record Change Form/www.udmercy.edu/hr/benefits/medical/hap_pdf/HAP Membership and Record Change Form.pdf0Hap Sumamry Description.pdfBenefit OverviewBenefit Overview/www.udmercy.edu/hr/benefits/medical/hap_pdf/Hap Sumamry Description.pdf304596HAP_Summary_of_Benefits_and_Coverage.pdfSummary of Benefit CoverageSummary of Benefit Coverage/www.udmercy.edu/hr/benefits/medical/hap_pdf/HAP_Summary_of_Benefits_and_Coverage.pdf381822/www.udmercy.edu/hr/benefits/medical/hap_pdf/formsforms
hap_mail_orderMail Order Prescription Drug Plan (link)Mail Order Prescription Drug Plan (link)/www.udmercy.edu/hr/benefits/medical/hap_link/hap_mail_orderhttp://www.hap.org/formulary/mo_prescriptions.php/www.udmercy.edu/hr/benefits/medical/hap_link/formsforms

Spousal Coordination

Spousal_Coordination_Form_2010_Revised.doctrue1435682128435nelsontdSpousal Coordination FormSpousal Coordination Form/www.udmercy.edu/hr/benefits/medical/spouse_pdf/Spousal_Coordination_Form_2010_Revised.docpalmersc1259001699317palmersc1259001726834796672UDM_Spousal_Coordination_FAQ.doctrue1435682128435nelsontdUDM Spousal Coordination FAQUDM Spousal Coordination FAQ/www.udmercy.edu/hr/benefits/medical/spouse_pdf/UDM_Spousal_Coordination_FAQ.docpalmersc1259001700540palmersc125900175727332256/www.udmercy.edu/hr/benefits/medical/spouse_pdf/formsforms

Health Care Credit

Health_Care_Credit_2014-15_memo.pdfHealth Care Credit Memo: 2014-15Health Care Credit Memo: 2014-15Health Care Credit Memo: 2014-15/www.udmercy.edu/hr/benefits/medical/credit_pdf/Health_Care_Credit_2014-15_memo.pdf0HCC_Waiver_Form.pdfHealth Care Credit Waiver FormHealth Care Credit Waiver Form/www.udmercy.edu/hr/benefits/medical/credit_pdf/HCC_Waiver_Form.pdf104096/www.udmercy.edu/hr/benefits/medical/credit_pdf/formsforms