Benefits Plans - health plans
The university offers you a number of health plan coverage options: health maintenance organization (HMOs), preferred provider organization (PPOs), and traditional "fee-for-service" plans. The health plan options differ in the benefit levels they provide, the doctors and hospitals you can use, and the cost to you. See Choosing a Plan for information to help you determine which option is right for you.
Health Plan Rates
The Health Plan Navigator allows you to view side-by-side comparison charts of only the U-M health plans you select to help you decide which plan is right for you. You can select certain plan features that may be particularly important to you, enter your zip code to view plans available in your area, or choose specific plans to compare with your current health plan coverage.
To ensure that you are enrolled in the health plan coverage of your choice, you must enroll in a health plan within 30 days of your service date (first day on the U-M payroll) or newly eligible date, or as specified by your collective bargaining agreement. If you do not enroll within the deadline, you will be defaulted into no health plan coverage and no prescription drug coverage, unless specified by your collective bargaining agreement. See Benefit Enrollment Deadlines and Defaults (PDF) for more information.
Within each health plan, you choose the level of coverage. The levels are:
- You only
- You + Adult
- You + Adult + Children
- You + Child
- You + Children
"Adult" refers to your spouse or other qualified adult.
"Children" refers to your dependent children.
Coverage is effective on your service date. Any applicable retroactive employee contribution amounts will be deducted for any full month(s) of coverage from your next paycheck. This may occur if you make your benefits elections late in the 30-day election period. Therefore, it is recommended that you make your benefits elections as soon as possible.
If you are eligible, you can receive an opt-out credit of $66.67 in your paycheck each month if you waive U-M health plan coverage because you have group health coverage outside the university through the employer of your spouse or OQA. If you and your spouse or other qualified adult both work for the university, you are not eligible to receive opt-out credit dollars for waiving health plan coverage for yourself if you enroll in benefits under your spouse's or OQA's university coverage.
To receive opt-out credit dollars, you must enroll online or return your enrollment form within your 30-day enrollment period, indicate that you wish to waive health plan and prescription drug coverage, and include your other coverage information where required.
Please note: Opt-out credit dollars for waiving U-M health plan coverage will be eliminated as of January 1, 2014.
Your health plan ID cards will be mailed to you directly from your health plan company, not from the Benefits Office, within four to six weeks after you enroll in benefits and receive your confirmation statement.
Services Before You Get Your ID Card
Contact your health plan company to find out how to receive services before your health plan cards arrive. Until you receive your cards, you may have to pay for health care services and/or prescriptions in full. Contact your health plan company to find out its reimbursement procedure.
The university does not have a pre-existing condition exclusion clause in any of its health plan contracts.
Women’s Health and Cancer Rights
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
- All stages of reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedemas.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under each of the University-sponsored medical plans.
Group health plans and health issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
The Benefits Office has designated a specific staff member who is a member of the LGBT Ally Program and is knowledgeable about and sensitive to transgender persons and the unique benefit related issues confronting them. Faculty and staff members with general or specific questions regarding benefit issues related to their transgender status are encouraged to contact Kate Van Valkenburgh for assistance. She can be reached directly at 734-647-4021 or by email at email@example.com.
Prescription Drug Plan
When you enroll in a U-M health plan, you will be concurrently enrolled in the Prescription Drug Plan.
Dollar Saver Tip
You can use a Health Care Flexible Spending Account for health care expenses for you and your covered dependents beyond what your plan covers. See the Flexible Spending Accounts section for details.
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.