For questions regarding your medical benefits and COVID, please see our COVID-19 FAQ. If you are outside of Ann Arbor/Dearborn/Flint, you may be able to qualify for “off-site GradCare registration”, which would allow you to access covered benefits where you are, as long as you are in the United States. To do so, you and your department fill out this form.
- Introduction to GradCare and Healthcare Benefits
- Dental and Vision Coverage
- Medical Leave
- Federal COVID Leave
- Abortion Coverage
Introduction to GradCare and Healthcare Benefits
- GradCare: Employees in the bargaining unit, their dependents, and Other Qualified Adults (see below for the definition) are eligible for GradCare coverage, including prescription drug coverage. The University’s formula for their contribution translates to zero-premium coverage. Prescription drug copays are capped annually at $2,500 per individual and $5,000 per family. Mental health copays are capped annually at $500 per individual and $1,000 per family.
- Summer Coverage: If you are employed in the Winter term and will be employed in the following Fall term OR were employed in the previous Fall term, your benefits coverage extends through the summer, regardless of whether you are employed in the Spring/Summer terms.
- Additional Benefits: Employees with a 0.25 fraction or above are eligible for a number of additional benefits that are also provided for non-bargained for instructional staff, including Life Insurance, Vision Plan, Legal Plan, Flexible Spending Accounts for Health and Dependent Care, Travel Accident Insurance, and Supplemental Retirement Plan. To view your full benefits, see the UM Benefits Page.
- Universal Health Services (UHS): UHS is a campus health center at the Ann Arbor campus, offering a variety of health care services. Copays at UHS are waived, as they’re covered under the health services fee billed to everyone. The absence of a comparable health care center at the Flint and Dearborn campuses is a major point of inequity.
- Emergency and After-Hours Services: For an overview of urgent or after-hours treatment options, see here.
- Gender-affirming health care: Beginning July 1, 2020, Gradcare covers 15 annual sessions of speech language therapy for the treatment of gender dysphoria (with a $25 copay). In addition, Gradcare covers procedures including hormone replacement therapy, mastectomy, fertility preservation, major and minor genital reconstruction surgery, permanent hair removal, tracheal shave, and facial feminization surgery. For further information, see the Trans Healthcare page.
- Fertility treatments including IVF: Gradcare also offers medical benefits related to fertility treatments, including In Vitro Fertilization (IVF). Under this plan, the majority of fertility procedures and medications are covered either mostly or in full. Specific to IVF, procedures are covered at a rate of 80% of the cost for the first round only; any procedures related to subsequent rounds are 100% out-of-pocket. Generally, medications required for one full round of IVF are fully covered, but this may vary on a case-by-case basis. Preimplantation genetic screening, however, is not covered by this plan. Upon meeting with a fertility specialist, individuals covered by this plan will receive a letter with additional information from the insurer.
- Mental Health Copay Cap: Our contract guarantees that individuals pay no more than a fixed amount for mental health office visits. Beginning January 1, 2021 through plan year 2023, that out-of-pocket amount is capped at $500 per individual and $1,000 per family. For detailed information and instructions on ensuring you are not charged beyond the cap, see this page.
Where to go for help: If you have issues with your benefits, we recommend going to the Managed Care team at University Health Services, who can help you deal with the insurance providers.
Some Terms to Know:
- Copay: A fixed amount you pay each time you go to a medical appointment; for most non-emergency procedures our copay is $25 or $30.
- Dependent: A child or relative meeting certain conditions, including living with the Employee. A dependent is eligible to be added to an employee’s Gradcare plan for no additional cost, as well as qualifying for other additional benefit plans.
- Deductible: The annual amount you pay for covered health care services before your insurance plan starts to pay. For example, if you have a $50 deductible, you will pay for the first $50 of covered care you receive, after which your insurance will begin paying.
- Gradcare: Our employer-provided health care coverage. Gradcare covers primarily “in-network” providers, which in practice means providers in southeast Michigan, although it does include telemedicine coverage accessible from anywhere.
- In-network Provider: An in-network provider is a physician whose services are covered by GradCare. For example, the in-network providers in Ann Arbor include University Health Service, Michigan Medicine hospitals and clinics, and other participating community providers. You can search in-network providers here.
- Premium: The annual (or monthly) amount paid by an employee for a benefit. For our GradCare coverage there is no premium.
- Primary Care Physician: GradCare coverage requires that you are referred to “speciality” health services by your “primary care physician”. Upon enrolling in GradCare, you will want to select a primary care provider; if you do not, one will be assigned to you. You can change your PCP at any time by calling BCN Customer Service at (800) 658-8878.
- Other Qualified Adult: Someone with whom an employee has shared a primary residence for six months (and who is not a parent, grandparent, employee, or tenant). An other qualified adult is eligible to be added to an employee’s Gradcare plan for no additional cost, as well as qualifying for other additional benefit plans.
Dental and Vision Coverage
Dental Coverage: You are entitled to the Option 1 dental coverage plan, premium free. This option covers oral exams and cleanings, twice per year, and some emergency procedures. You can opt in to dental coverage for your spouse, dependents, or OQA for additional cost.
You can increase your dental coverage by enrolling in higher tiers, which have associated monthly premiums. Option 2 (~$15 monthly premium per enrollee with a $50 annual deductible) covers dental procedures only at “Preferred” providers. Option 3 (~$23 monthly premium per enrollee with a $50 annual deductible) expands coverage to “Premium” providers. Up-to-date costs can be found here, and detailed information on each plan here.
Vision coverage: Annual eye exams are already covered under Gradcare. If you are working a .25 fraction or above, you are eligible for the University’s Vision Care coverage (premiums are about $8 monthly for an individual, with higher rates for additional enrollees). Vision coverage pays for one pair of glasses per year, or a years-supply of contact lenses. There are limitations to what is covered beyond “basic” eyewear provided by Davis Vision; UHS has an eye clinic and shop which accepts this insurance and can answer questions about other clinics/optician coverage. For a complete list of covered items, see here.
Our contract grants us six weeks of paid medical leave annually, which can be used for “personal illness, injury, medical appointment, medical procedure, or other disabling medical condition, or because of the illness, injury, medical appointment, medical procedure, or other disabling medical condition of a family member or Other Qualified Adult”. No documentation is required to access your medical leave.
Federal Emergency Paid Sick Leave
In addition, recent federal legislation granted up to 80 hours of paid time off (prorated based on employment fraction) for COVID-19-related absences. This time can be used for COVID-19 absences, including: personal illness, direction to quarantine, care for a quarantined individual whose care is the responsibility of the employee, or to provide child care due to school or daycare closure.
Section 8.9(d), Termination of Pregnancy:
Coverage includes first trimester elective termination of pregnancy and therapeutic termination in the 2nd or 3rd trimester in accordance with locally accepted medical practice.
Level 1 – $30 Copayment for each office visit(p.49)
Level 2 – $30 Copayment for each office visit
Level 3 – Not covered
Level 1 refers to benefits for services provided by the Member’s Primary Care Physician or referred by the PCP and performed by a Participating Provider.(p.v)
Level 2 refers to benefits for services provided by any Provider outside of the GradCare Service Area as part of an approved off-site academic course of study or other field placement.
Level 3 refers to benefits for services provided by a Provider outside the GradCare Service Area without a referral from the Member’s Primary Care Physician when a Member is traveling temporarily outside the GradCare Service Area (e.g., during a school break.) Member is responsible for any Balance Billed amounts billed by the Provider that exceed the Approved Amount.
Approved Amount also known as the Allowed Amount is the lower of the billed charge or the maximum payment level BCN will pay for the Covered Services. Copayments which may be required of you are subtracted from the Approved Amount before we make our payment.(p.iii)