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REGIONAL HEALTH PLANS

Please select the plan below to view details.

University of Michigan Health believes in offering health insurance choices which support your, and your family’s, health care needs!

Health Insurance - High Level Regional Plan Comparisons

BRONZE HEALTH PLAN  SILVER HEALTH PLAN GOLD HEALTH PLAN
Plan Type HDHP PPO PPO PPO
Network UM Health Network

(Maximum Savings)

 BCBSM Network

(Standard Savings)

 UM Health Network

(Maximum Savings)

 BCBSM Network

(Standard Savings)

 UM Health Network

(Maximum Savings)

BCBSM Network

(Standard Savings)
Employer HSA Funding (EE/Sp/Ch/Fam) $750 / $1,500 (prorated based on effective date) N/A N/A
Coinsurance Plan pays 100% after deductible Plan pays 70% after deductible Plan pays 90% after deductible Plan pays 70% after deductible Plan pays 90% after deductible Plan pays 80% after deductible
Deductible (Ind/Fam) $1,700 / $3,400 $3,000 / $6,000 $500 / $1,000 $1,500 / $3,000 $0 / $0 $500 / $1,000
Embedded vs. Non-Embedded Deductible* Non-Embedded  Non-Embedded Embedded Embedded Embedded Embedded
Out-of-Pocket Max (Ind/Fam) $3,000 / $6,000 $5,000/ $10,000 $2,000 / $4,000 $6,000 / $12,000 $1,000 / $2,000 $3,000 / $6,000
Annual Preventive Care 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered
Office Visit (Primary/Specialist) Plan pays 100% after deductible Plan pays 70% after deductible $25 / $40 copay $45 / $65 copay $10 / $15 copay $30 / $50 copay
Inpatient Hospitalization (including maternity care for delivery/stay) Plan pays 100% after deductible Plan pays 70% after deductible Plan pays 90% after deductible Plan pays 70% after deductible Plan pays 90% after deductible Plan pays 80% after deductible
Maternity (Pre and Post-Natal Care) 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered
Outpatient Procedures Plan pays 100% after deductible Plan pays 70% after deductible Plan pays 90% after deductible Plan pays 70% after deductible Plan pays 90% after deductible Plan pays 80% after deductible
Urgent Care Plan pays 100% after deductible Plan pays 70% after deductible $50 copay $75 copay $25 copay $50 copay
Emergency Room Plan pays 100% after deductible Plan pays 70% after deductible $200 copay $250 copay $100 copay $150 copay
     Prescription Drugs
Rx Deductible (Employee/Family) Same as above (Rx copay after deductible) None None
Retail (Generic / Preferred / Non-Preferred / Specialty) $5 / $25 / $50 / $75 $10 / $40 / $80 / $100 $5 / $25 / $50 / $75 $10 / $40 / $80 / $100 $5 / $25 / $50 / $75 $10 / $40 / $80 / $100

*Non-Embedded deductibles: full family deductible must be met when more than one person enrolled.  Embedded deductibles: individual deductibles apply.

View the 2026 Benefit Guide

Non-Union Rate Sheet

 

Health Plan Third Party Administrator (TPA) information:

  • Blue Cross Blue Shield of Michigan – Third Party Administrator (Medical)
    • Contact for support with medical claims, BCBSM insurance cards or for support with the Blue Cross portal/website.
  •  Health Plan Network Lookup/Provider Directory Link (BCBSM) 
    • The easiest way to lookup network providers is by creating an account with BCBSM – you will not be able to create an account until your coverage is active (ex. 1/1/2026)
    • Flyer: What Members Can Find in their BCBSM Member Account Portal
    • For manual lookups, please note there are three different networks for our various plans:
      • Regional Bronze, Silver and Gold Plans: select “U-M Health Regional Network”
      • MNA PPO Plus: select “Sparrow MNA PPO Plus”
      • MNA BCBSM and BCBSM Retiree Plans: select “Sparrow MNA-PECSH BCBSM”
    • Please see the Provider Network Lookup flyer for more assistance

 

Pharmacy Benefit Manager information – RxBenefits (not applicable to the MNA BCBS Legacy plan):

  • RxBenefits – Pharmacy Benefit Manager (PBM)
  • Formulary:
    • Generic Policy – Dispense As Written (DAW):  If a Brand name drug is filled when a generic equivalent is available, you will be required to pay the Brand cost share plus the difference in cost between the Generic and Brand name drug.  The cost difference will not apply to the deductible, or the annual maximum out-of-pocket.
    • Compound Drugs:  For compound drugs to be covered, they must satisfy certain requirements. In addition to being medically necessary and not experimental or investigative, compound drugs must not contain any ingredient on a list of excluded ingredients. Any denial or coverage of a compound drug may be appealed in the same manner as any other drug claim denial under this coverage. Compounded medications equal to or exceeding $300 per script will require prior authorization.
    • 2025 RxBenefits Formulary Listing
    • 2026 RxBenefits Formulary Listing
    • 2026 Upcoming Rx Formulary EXCLUSION Listing
  • Maintenance Medications
    • UM Health-West team members must fill all maintenance medications at a U-M Health owned pharmacy
    • UM Health-Sparrow team members must fill listed maintenance medications (click to open) at a U-M Health owned pharmacy
    • First-fills for maintenance medications are an exception for all regional plans
  • Specialty Medications
    • Specialty medications are high-cost drugs that are often injected or infused and require special storage and monitoring. These medications must be obtained through U-M Health Pharmacy. Some exceptions apply. These medications are limited to a 1-30 day supply. Specialty medications largely fall into the formulary brand category but could also fall into the biosimilar or generic specialty drug category. These medications are subject to the appropriate copay / coinsurance as listed above.
    • Need specialty medications?  Contact UM Health-West Pharmacy at 616-252-RxRx (616-252-7979) or UM Health-Sparrow Specialty Pharmacy at 833-485-0222
    • SaveOnSP – Copay Assistance:  Specialty medications are used to treat complex chronic conditions and have a high cost. Your employer is offering a copay assistant program coordinated by SaveOnSP. Enrolling in the program provides the opportunity for $0 cost on select specialty medications, If you choose not to enroll, your responsibility will be 30% coinsurance. Please contact SaveOnSP at 800.683.1074 so a patient advocate can assist you with completing your enrollment.
    • SaveOnSP Flyer
    • SaveOnSP Drug List – January 2026

Additional Resources