FORMS
For your convenience, many forms can be submitted electronically through our secure online portal. Some of the forms you may see available in the portal include:
IMPORTANT DOCUMENTS
Additional documents are available through the secure online portal. Some of the documents you may see in the portal include:
FAQS
How do I change my address?
In order to change your mailing address, you must complete a Change of Address Form and return it to the Fund Office.
How do I change my name?
In order to change your name, you must complete a Change of Name Form and submit it to the Fund Office. Please include a copy of one of the following forms of documentation: current driver’s license, current state identification card, current passport, official birth certificate, official marriage certificate, or naturalization documentation.
How do I order a new health ID Card?
You can order a new health ID card online or by calling BCBSM at (877) 790-2583, or by calling the Fund Office.
How do I locate a health network provider?
You can view network providers by visiting the provider websites: BCBSM, VSP, and Delta Dental of Michigan.
How do I view my Explanation of Benefits (EOB)?
If you did not receive an EOB in the mail or need to request a new one, please contact BCBSM or Delta Dental of Michigan.
How do I designate a beneficiary for the Burial Benefit?
Complete a Health Care Fund Beneficiary Designation Form and mail to the Fund Office.
How do I add a dependent to my health insurance?
To enroll your spouse for coverage under the Plan, submit a completed Family Update Form along with a copy of the marriage certificate to the Fund Office or submit forms via the Participant Portal.
To enroll your dependent child for coverage under the Plan, submit a completed Family Update Form along with a copy of the birth certificate or adoption papers to the Fund Office.
Additional documentation may be requested by the Fund Office following receipt of the initial request.
To enroll your dependent child for coverage under the Plan, submit a completed Family Update Form along with a copy of the birth certificate or adoption papers to the Fund Office.
Additional documentation may be requested by the Fund Office following receipt of the initial request.
How can I find more information about the health benefits offered through my health plan?
The Summary Plan Description details the benefits of the health plan. The Summary Plan Description will provide information about the health plan such as covered medical expenses, prescription drug benefits, as well as vision and dental benefits if applicable under your plan classification.
How can I receive a copy of the Summary Plan Description?
Click to view the Summary Plan Description electronically, or you may contact the Fund Office to request a physical copy.
If I get divorced, what happens with my former spouse’s coverage?
You or your spouse must notify and submit a fully executed copy of your divorce decree to the Fund Office. Please also contact the Fund Office to complete a new Beneficiary Designation Form if there is a change in marital status. Once the divorce decree is received, your former spouse’s coverage will be terminated on the last day of the month in which you and your spouse divorced.
When I retire, what are my options for continuing health coverage?
If you meet certain criteria defined in the Summary Plan Description, you and your family may be eligible to participate in the Retiree Self-Pay Program or COBRA continuation coverage. Please contact the Fund Office for your options.
Who do I contact with questions?
If you have any questions about your eligibility or AD&D and burial benefits, please contact the Fund Office. For questions related to medical, pharmacy, and Medicare Advantage Prescription Drug (MAPD) benefits, please contact BCBSM. For questions related to dental benefits, please contact Delta Dental of Michigan. For questions related to vision, please contact VSP.