2013-2014 Medical/RX Rates (All UDM Employees)

(Amended Jan. 1, 2014)

Medical Group Number/Suffix Medical Plan &
Prescription
Coverage
Employee
Bi-weekly
Premium
Annual Premium
Paid by Employee
007005186-0000 BCBSM-PPO Comm Blue #1 24-Pays 19-Pays  
  Employee $111.09 $140.33 $2,666.16
  Employee + 1 $266.06 $336.08 $6,385.44
  Employee + Family $333.85 $421.70 $8,012.40
007005186-0004 BCBSM-PPO Comm Blue #3
  Employee $78.08 $98.62 $1,873.92
  Employee + 1 $186.91 $236.09 $4,485.84
  Employee + Family $234.68 $296.44 $5,632.32
10000681 Health Alliance Plan-HMO (HAP)
  Employee $77.50 $97.89 $1,860.00
  Employee + 1 $178.05 $224.91 $4,273.20
  Employee + Family $202.76 $256.12 $4,866.24

Plan Information

Preferred Provider Organization (PPO) BCBSM
Health Alliance Plan (HMO) HAP

BCBSM Customer Service
800-637-2227

HAP Customer Service
313-872-8100 or
800-422-4641