PUP-MI Forms


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Preferred United Plans of Michigan Forms
100/70 Plan	72KB
90/70 Plan	72KB
90/60 Plan	72KB
80/50 Plan	72KB
70/50 Plan	1.1MB
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	56KB
Proposal Request Form	56KB
Employer Group Application	172KB
Group Employee Application	236KB
Supply Order Form	33KB