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PUP-MI Forms
PUP-MI Forms
General Forms
Preferred United Plans of Michigan Forms
100/70 Plan
46KB
90/70 Plan
45KB
90/60 Plan
44KB
80/50 Plan
47KB
70/50 Plan
47KB
HSA 100
(deductibles and coinsurance combined in and out of network)
80KB
HSA 100-2
(deductibles and coinsurance separate in and out of network)
80KB
HSA 80
(deductibles and coinsurance combined in and out of network)
76KB
HSA 80-2
(deductibles and coinsurance separate in and out of network)
76KB
Prescription Drug Plans
183KB
Proposal Request Form
172KB
Employer Group Application
156KB
Group Employee Application
172KB
Supply Order Form
33KB
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