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.

Providers were originally notified in Nov. 2024 of the decision to wind down the plan. Communications are also posted on the UM Health Plan website and provider portal. Ongoing communications will occur throughout the remainder of the year regarding closure and winddown activities.

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.

Providers can utilize the provider portal to verify member eligibility. They can also contact our Customer Service team for benefit coverage and eligibility information. It is the responsibility of the provider to verify member eligibility at the time of each visit to ensure active coverage for that date of service, as some groups have disenrolled throughout 2025 plan year.

Individual and group members: UM Health Plan will accept claims for processing as outlined in the providers participation manual and provider agreement. Electronic claims will be accepted through July 31, 2026.

Medicare members: UM Health Plan will accept in-network provider claims through June 30, 2026. Out-of-network provider claims can be submitted through Dec. 31, 2026.

In Network Payer ID

Commercial: 37330

Medicare: 83276

Out of Network Payer ID

Commercial: 07689  

Medicare: 83276

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All paper claims submitted must be received as outlined in the provider manual. We expect all claims to be received and processed by Dec. 31, 2026.

Commercial paper claims can be sent to:    

In Network

P.O. Box 313, Glen Burnie, MD 21060-0313

Out of Network

P.O. Box 247, Alpharetta, GA 30009-0247

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Medicare paper claims can be sent to:  

P.O. Box 7119, Troy, MI 48007

After July 31, 2026 – All commercial paper claims should be submitted to:

P.O Box 30377, Lansing, MI 48909-7877

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We encourage all providers to submit claims promptly to ensure prompt payment and processing. Claims not submitted within the terms of the participation agreement may be denied or rejected.

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: The provider portal is available through Mar. 31, 2026. After the portal is no longer available, a provider with Medicare inquiries can contact customer service at 844-529-3759.

Individual and group members: The portal is available through June 30, 2026. After the portal is no longer available, a provider can contact customer service for assistance at 800-832-9186.

Effective Jan. 31, 2026, UM Health Plan will no longer accept untimely requests or notifications once the member’s eligibility and benefits have terminated.  

Please note that requests submitted through EZ Auth/Referrals, fax, email, phone, or the online exception process with not be accessible after Jan. 31, 2026.

Providers seeking a claim review for services, procedures, or items without a prior authorization must follow the standard claim submission process and include all necessary documentation.  

For medical, untimely request/notifications will no longer be accepted by UM Health Plan after the member’s eligibility and benefits terminate with the health plan. The provider can follow the claim submission process with applicable documentation for a claim review if an authorization was not obtained prior to services, procedures, or items being provided. EZ Auth/Referrals and requests received by fax and through the online exception process will not be accessible after Jan. 31, 2026.

The provider and member must coordinate with the new health plan to reauthorize services, procedures, and items. They will need to follow the new plan’s policy for transition and continuity of care.

The provider and member will work with the member’s new health plan to determine which services, procedures, and items will require a new authorization and/or follow policy guidelines for transition and continuity of care needs.

It is important to keep UM Health Plan up to date on all provider information during the duration of time we are processing claims and for year-end tax purposes. The form for all updates and changes can be obtained on the UM Health Plan website, under Providers/Forms. You can send via email, fax, or mail at the locations indicated on the website.

1099s will be provided in accordance with applicable laws, which generally state 1099s must be sent by Jan. 31. For questions regarding your 1099s 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.

UM Health Plan is required to comply with all audit and regulatory requirements for any coverage year under contract. This will include audits of prior year(s) activity, which will require medical record validation. CMS has announced intent to complete Medicare Advantage RADV audits for coverage years 2018-2024, which will require UM Health Plan to obtain medical records from participating offices to support these CMS audit activities.    

Copies of the requested medical records must be received within 14 days of the request. Records may be provided in the following ways:

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Physical Mail

UM Health Plan Medical Record Request Team

P.O Box 30377

Lansing, MI 48909-7877

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Fax

517-364-8408

Attn: RADV Audit

Alternative Fax: 517-364-8460

Secure/Encrypted Email

QualityDepartment@UofMHealthPlan.org

Electronic

For flash drive or CD, please email pass codes to QualityDepartment@UofMHealthPlan.org

Onsite Review or Pick Up

Call or email to schedule

Providers are required to comply with all terms of their participation agreement with UM Health Plan that were in force at the time of the rendered service. As outlined in the providers participation agreement, payor shall have access to all records related to the obligations and health services being audited for ten (10) years following termination.  Copies of medical records must be sent within fourteen (14) days from the date the request is made.

Medical records should be sent as outlined in the medical request communication or as outlined below:  

Physical Mail

UM Health Plan Medical Record Request Team

P.O Box 30377

Lansing, MI 48909-7877

Fax

517-364-8408

Attn: RADV Audit

Alternative Fax: 517-364-8460

Secure/Encrypted Email

QualityDepartment@UofMHealthPlan.org

Electronic

For flash drive or CD, please email pass codes to QualityDepartment@UofMHealthPlan.org

Onsite Review or Pick Up

Call or email to schedule

In accordance with most provider participation agreements, the agreement specifies, “Provider will maintain adequate medical, ...administrative records related to Health Services rendered by Provider under this Agreement. Payor, .....upon reasonable notice and demand in writing or in person, shall have access to and the right to audit all information and records, and to make copies of such records at no charge, related to all of Provider and Participating Providers’ obligations and Health Services rendered by Participating Providers under this Agreement.”

Refer to your UM Health Plan participation agreement to determine if reimbursement for record retrieval is defined or if it may be charged to UM Health Plan. If your office utilizes a third-party service to retrieve, copy, and send records, you need to ensure your service provider is aware of the limits of the fee.

Individual and group: The UM Health Plan Customer Service team will be available through Aug. 31, 2026.  You can contact them at 800-832-9186.

Medicare: The Medicare provider service number is 844-529-3757. Medicare customer service call center is available through May 31, 2027.

Active authorization will terminate when a member’s eligibility and benefit plan with UM Health Plan ends.  

Active authorizations will end when the member’s eligibility and benefit plan terminates with UM Health Plan. Authorizations will not extend past non-active membership.

UM Health Plan will continue to conduct audits and process claims, recoupments, overpayments, and adjustments throughout 2026 for services incurred during the coverage period.

ERA and EFT will continue through the Health Plans usual process through Aug. 31, 2026. After Aug. 31, 2026, all payment/processing will be completed via paper remittance and check.

Providers will have 60 days from the date a claim is processed to submit an appeal. All providers should submit claims promptly to ensure prompt payment and processing. Claims not submitted within the terms of the participation agreement may be denied or rejected.

UM Health Plan will send notice of final contract termination in accordance with the terms outlined in providers’ participation agreements. Providers are required to comply with all terms of their participation agreement with UM Health Plan that were in force at the time of the rendered service.

Primary care providers eligible for the incentive payment can expect reports and payment by Dec. 31, 2025.

Please refer to the Notification/Prior Authorization Table

Providers can check eligibility and claim status within the Provider Portal.

Submit your claims to the following address:

Global-Care
‍PO Box 247
Alpharetta, GA 30009-0247

Or submit your claim electronically by using the following information:

Payor ID: 07689
Payor Name: UM Health Plan

Please review the Provider Directory or contact Customer Service at 800-832-9186 for commercial members or 800-661-8299 for UM Health-Sparrow members.

Your office will need to submit a Provider Information Update Form.

UM Health Plan does release fees, but we ask that you please contact your provider relations coordinator directly at ProviderRelations@UofMHealthPlan.org.

Review the latest Provider Manual.