UM Health Plan Coverage Ends Dec. 31, 2025*

UM Health Plan is closing operations and will terminate all current health plan coverage as of Jan. 31, 2026. Some coverage may end before this date, so check the member ID card to verify the correct payer by dates of service. The members who are currently being served will transition to other payers between now and Feb. 1, 2026.

Like many health plans, UM Health Plan has experienced significant financial losses over the past few years. After a thorough business and financial assessment, UM Health has made the difficult decision to close UM Health Plan.

This announcement comes after a comprehensive evaluation of the plan’s financial sustainability, market trends, and the evolving needs of our members.

We recognize the importance of affordable and reliable health care, and this decision was not made lightly. Despite significant efforts to maintain the plan, the increasingly competitive health insurance landscape, and the Centers for Medicare & Medicaid Services (CMS) changes to Medicare Advantage plans have made it unsustainable to continue offering the high level of service our members deserve. We are deeply committed to our members, agents, employers, and providers, and will continue to serve all these groups and all members’ claims for services provided through the coverage period.

UM Health Plan is closing. Member coverage will end in accordance with their current covered plan time frame.

The decision to close UM Health Plan in 2025 for plan year 2026 does not impact members’ current medical or pharmacy benefits administered by UM Health Plan. New health plan coverage will need to be selected after UM Health Plan coverage ends.

UM Health Plan will cover medically necessary services members require through the term of the Medicare Advantage beneficiary’s, individual's, or group’s contract, respectively.

Yes, UM Health Plan has a strong relationship with our contracted network of providers and do not anticipate any issues with our network or our providers' ability to continue being accessible and available to our members. UM Health Plan, together with our provider and hospital system partners across Michigan, share a commitment to helping people access the care they need, close to home and will continue to cover medically necessary services our members require through the term of the Medicare Advantage beneficiary’s, individual's, or group’s contract.

Yes, claim(s) for covered services received during the coverage period will be paid in 2026, per the contract benefit.

Medicare members: Yes, claims for services incurred at any time in 2025 will be paid, including inpatient stays. CMS regulation 42 CFR 422.318 establishes special rules for coverage that begins or ends during an inpatient hospital stay. The regulation requires UM Health Plan to pay for your inpatient hospitalization services from the date of admission while a member of our plan, through the date of discharge, even if the member is effective on Original Medicare or another MA-PD plan.

‍Individual members: Coverage ends on the date of termination – Dec. 31, 2025 – even if a member is hospitalized or otherwise receiving medical treatment on that date.

‍Group members: UM Health Plan will cover medically necessary services members require through the term of the group’s contract.

Individual and group members: Written notification about the plan ending will be mailed to Individual and Group members no later than Oct. 2, 2025.

Medicare members: Members’ written notifications of the plan ending will be mailed no later than Oct. 2, 2025.

Individual and group members: Written notification about the plan ending will be mailed to Individual and Group members no later than October 2, 2025.

Medicare members: Written notifications of the plan ending will be mailed to members no later than Oct. 2, 2025.

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Individual members: Individual members are being encouraged to use the Health Insurance Marketplace (HealthCare.gov) to find other Health Insurance Marketplace plans or contact an independent agent who can assist them in choosing a new plan.  

Group members: Group members should contact their employer for information on the new plan selections offered to them.

Medicare members: Medicare members can visit Medicare.gov to compare plans, see what fits their needs, and enroll online or talk with a licensed Medicare agent who can help explore options and answer questions specific to the member. Annual enrollment period is Oct. 15 through Dec. 7, 2025. If a member misses the annual enrollment period, they will have a special enrollment period (SEP) from Dec. 8, 2025 through Feb. 28, 2026.

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Individual members: Coverage ends for individual members on Dec. 31, 2025.

Group members: Group members’ coverage end dates vary dependent on each employer. Please contact your employer for 2026 plan options.

Medicare members: Coverage ends for Medicare members on Dec. 31, 2025.

Your benefit card will no longer work once your benefits are no longer active. Members and providers can verify coverage dates by utilizing our Member portal and Provider portal. Benefit cards will no longer be mailed to members after Nov. 30, 2025; however, members can view their benefit card by accessing their account on the Member Portal.

Whether to accept deductible transfers from UM Health Plan is up to the new plan. If the new plan wishes to receive this information, they can request a report by sending an email to Customer.Service@UofMHealthPlan.org, within 30 days of the group’s or member’s termination with UM Health Plan.

Group members should contact their employer for information on the new plan selections offered to them.

If you pay for health care services, it is best that requests for reimbursement be submitted within 90 days of the date of service. If UM Health Plan does not receive a claim within one year of the date of service, the health care services may not be covered. If your claim relates to an inpatient stay, the date of service is the date your inpatient stay ends.

If you are submitting a member reimbursement request for a pharmacy service after June 30, 2026, written notification of the claim must be given to the plan at the address below.

All medical reimbursements after Jan. 1, 2026, and pharmacy reimbursements after June 30, 2026, send to:

PO Box 30377
Lansing, MI  48909-7877

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Medicare members: Medicare beneficiaries can be enrolled into our plan through Dec. 1, 2025 effective dates. Agents can use the producer portal for submitting enrollments. UM Health Plan does not pay commissions for new enrollments in 2025. The Medicare producer portal is available through April 30, 2026, so agents/producers can access commission statement information.

Individual and group members: Member:  

The portal login page can be found here: https://www.uofmhealthplan.org/login

To create an account, you will need the policy numbers from your Member ID card.

Through your portal account you can order new ID cards, view and print claim information, such as Explanation of Benefits, and update your primary care provider (PCP) information.

Annual tax documents will be provided in accordance with applicable laws, which generally state 1099s must be sent by January 31. For questions regarding your annual tax documents please email Finance@UofMHealthPlan.org.

Medicare members: The Medicare customer service call center will be available through May 31, 2027.

Individual and group members: The UM Health Plan Customer Service call center will be available through Aug. 31, 2026.

Please contact Sales at Sales@UofMHealthPlan.org for information for quotes or groups.

Contact Sales at Sales@UofMHealthPlan.org to request enrollment and eligibility changes.

To find a participating doctor, visit the Provider Directory.

At this time, groups cannot pay their premiums online. Employer groups can send checks to the following address:

For HMO Plans:

University of Michigan Health Plan

PO Box 776180

Chicago, IL 60677-6180

For PPO Plans:

University of Michigan Health Plan

PO Box 776178

Chicago, IL 60677-6178

Groups are able to set up ACH payments to UM Health Plan. Employer groups must initiate the payment through their financial institution.

For more information contact Finance at 888-892-0009.

Yes - the maximum-out-of-pocket (MOOP) amounts include the deductibles.

In order for your group to take part in an HMO plan or a POS plan through UM Health Plan, your employees must live or work within our service area. HMO or POS members who live or work outside of the service area must agree to receive services from in-network providers.

If your group offers a PPO plan, and you have a new enrollee who lives outside of the service area, please notify your account manager so that the new enrollee can be placed in the appropriate network class to receive in-network benefits.

UM Health Plan offers a statewide network of providers and facilities. A member who has an urgent or emergency situation when traveling outside the service area should visit the nearest urgent care center or emergency department, regardless of whether it is in the network. Urgent Care and Emergency services are always covered under a member's in-network benefit, in all 50 states and worldwide.

It is a list of prescription drugs covered by a particular drug benefit plan. UM Health Plan, in conjunction with its pharmacy benefit manager, Express Scripts, Inc. (ESI), reviews its Prescription Drug Lists on a regular basis to ensure that they are up-to-date.

There are no pre-existing clauses under any UM Health Plan policies.

You can make enrollment changes in a number of ways:

• Make changes in the Employer Portal
• Submit the necessary forms to Enrollment at Enrollment@UofMHealthPlan.org
• Call your account manager.

Changes may take up to 48 hours to be effective.

Please fill out and return the Case Management Referral Form to CaseManagement@UofMHealthPlan.org.