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| Plan Name | PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | PREMIER HEALTH CARE MANAGEMENT INC. |
| Employer identification number (EIN): | 383024426 |
| NAIC Classification: | 541600 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-01-01 | ||||
| 501 | 2018-01-01 | ||||
| 501 | 2017-01-01 | ||||
| 501 | 2016-01-01 | ||||
| 501 | 2015-01-01 | ||||
| 501 | 2014-01-01 | ||||
| 501 | 2013-01-01 | ||||
| 501 | 2012-01-01 | TIMOTHY C SPIRO | |||
| 501 | 2011-01-01 | TIMOTHY C SPIRO | |||
| 501 | 2009-01-01 | TIMOTHY C SPIRO |
| 2019: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-01-01 | Type of plan entity | Mulitple employer plan |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Mulitple employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Mulitple employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Mulitple employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Mulitple employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2014 form 5500 responses | ||
| 2014-01-01 | Type of plan entity | Mulitple employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2013 form 5500 responses | ||
| 2013-01-01 | Type of plan entity | Mulitple employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2012 form 5500 responses | ||
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: PREMIER HEALTH CARE SECOND AMENDED AND RESTATED WELFARE BENEFIT PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 05G5149 |
| Policy instance | 12 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 05G5278 |
| Policy instance | 13 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 248019 |
| Policy instance | 1 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 3604 |
| Policy instance | 2 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 248019 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600024 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600025 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 423916 |
| Policy instance | 6 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 05G5146 |
| Policy instance | 7 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 05G5603 |
| Policy instance | 8 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 05G5399 |
| Policy instance | 9 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 05G5401 |
| Policy instance | 10 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 05G5281 |
| Policy instance | 11 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 423916 |
| Policy instance | 6 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600025 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600024 |
| Policy instance | 4 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 248019 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 248019 |
| Policy instance | 1 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 3604 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513259 |
| Policy instance | 7 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514400 |
| Policy instance | 8 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513492 |
| Policy instance | 15 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514628 |
| Policy instance | 14 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512869 |
| Policy instance | 13 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512472 |
| Policy instance | 12 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512522 |
| Policy instance | 11 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512521 |
| Policy instance | 10 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513028 |
| Policy instance | 9 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600025 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600024 |
| Policy instance | 4 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 248019 |
| Policy instance | 3 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 3604 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 248019 |
| Policy instance | 1 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512521 |
| Policy instance | 10 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 423916 |
| Policy instance | 6 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513259 |
| Policy instance | 7 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514400 |
| Policy instance | 8 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513492 |
| Policy instance | 15 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514628 |
| Policy instance | 14 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512869 |
| Policy instance | 13 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512472 |
| Policy instance | 12 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512522 |
| Policy instance | 11 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513028 |
| Policy instance | 9 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0007 |
| Policy instance | 8 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0008 |
| Policy instance | 9 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0009 |
| Policy instance | 10 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0010 |
| Policy instance | 11 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0012 |
| Policy instance | 13 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0014 |
| Policy instance | 14 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0006 |
| Policy instance | 7 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0005 |
| Policy instance | 6 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0004 |
| Policy instance | 5 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0002 |
| Policy instance | 4 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0001 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 229952 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 52830 |
| Policy instance | 1 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0011 |
| Policy instance | 12 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0015 |
| Policy instance | 15 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0016 |
| Policy instance | 16 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0017 |
| Policy instance | 17 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513492 |
| Policy instance | 31 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514628 |
| Policy instance | 30 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512869 |
| Policy instance | 29 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512472 |
| Policy instance | 28 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512522 |
| Policy instance | 27 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512521 |
| Policy instance | 26 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513028 |
| Policy instance | 25 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514400 |
| Policy instance | 24 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513259 |
| Policy instance | 23 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0019 |
| Policy instance | 19 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0020 |
| Policy instance | 20 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600024 |
| Policy instance | 21 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600025 |
| Policy instance | 22 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0018 |
| Policy instance | 18 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513028 |
| Policy instance | 25 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514400 |
| Policy instance | 24 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512521 |
| Policy instance | 26 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512522 |
| Policy instance | 27 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512472 |
| Policy instance | 28 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512869 |
| Policy instance | 29 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514628 |
| Policy instance | 30 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513492 |
| Policy instance | 31 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0017 |
| Policy instance | 17 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513259 |
| Policy instance | 23 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600025 |
| Policy instance | 22 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0008 |
| Policy instance | 9 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0007 |
| Policy instance | 8 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0006 |
| Policy instance | 7 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0004 |
| Policy instance | 5 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0005 |
| Policy instance | 6 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0002 |
| Policy instance | 4 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0001 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 229952 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 52830 |
| Policy instance | 1 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0009 |
| Policy instance | 10 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0010 |
| Policy instance | 11 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600024 |
| Policy instance | 21 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0020 |
| Policy instance | 20 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0019 |
| Policy instance | 19 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0018 |
| Policy instance | 18 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0016 |
| Policy instance | 16 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0015 |
| Policy instance | 15 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0014 |
| Policy instance | 14 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0012 |
| Policy instance | 13 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0011 |
| Policy instance | 12 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0001 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 52830 |
| Policy instance | 1 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0010 |
| Policy instance | 11 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 036-7522-01 |
| Policy instance | 2 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0012 |
| Policy instance | 13 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0014 |
| Policy instance | 14 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0011 |
| Policy instance | 12 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0002 |
| Policy instance | 4 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0004 |
| Policy instance | 5 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0005 |
| Policy instance | 6 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0006 |
| Policy instance | 7 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0007 |
| Policy instance | 8 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0008 |
| Policy instance | 9 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0009 |
| Policy instance | 10 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0015 |
| Policy instance | 15 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0016 |
| Policy instance | 16 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0017 |
| Policy instance | 17 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600025 |
| Policy instance | 22 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512472 |
| Policy instance | 28 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513259 |
| Policy instance | 23 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514400 |
| Policy instance | 24 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513028 |
| Policy instance | 25 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512521 |
| Policy instance | 26 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512522 |
| Policy instance | 27 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512869 |
| Policy instance | 29 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0020 |
| Policy instance | 20 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0018 |
| Policy instance | 18 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0019 |
| Policy instance | 19 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 600024 |
| Policy instance | 21 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513492 |
| Policy instance | 31 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514628 |
| Policy instance | 30 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513259 |
| Policy instance | 23 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513028 |
| Policy instance | 25 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512522 |
| Policy instance | 27 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512521 |
| Policy instance | 26 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512472 |
| Policy instance | 28 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 512869 |
| Policy instance | 29 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514628 |
| Policy instance | 30 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 036-7522-00 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513492 |
| Policy instance | 31 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 514400 |
| Policy instance | 24 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 0008460837 |
| Policy instance | 22 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0002 |
| Policy instance | 4 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0004 |
| Policy instance | 5 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0005 |
| Policy instance | 6 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0006 |
| Policy instance | 7 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0007 |
| Policy instance | 8 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0008 |
| Policy instance | 9 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0009 |
| Policy instance | 10 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0010 |
| Policy instance | 11 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0011 |
| Policy instance | 12 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0012 |
| Policy instance | 13 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0014 |
| Policy instance | 14 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0017 |
| Policy instance | 17 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0016 |
| Policy instance | 16 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0018 |
| Policy instance | 18 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0019 |
| Policy instance | 19 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0020 |
| Policy instance | 20 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | R0122267 |
| Policy instance | 21 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0001 |
| Policy instance | 3 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0015 |
| Policy instance | 15 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 52830 |
| Policy instance | 1 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0005 |
| Policy instance | 6 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0004 |
| Policy instance | 5 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0002 |
| Policy instance | 4 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0001 |
| Policy instance | 3 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 513259 |
| Policy instance | 21 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 52830 |
| Policy instance | 1 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 036-7522-00 |
| Policy instance | 2 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0017 |
| Policy instance | 17 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0011 |
| Policy instance | 12 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0006 |
| Policy instance | 7 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0007 |
| Policy instance | 8 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0008 |
| Policy instance | 9 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0018 |
| Policy instance | 18 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0019 |
| Policy instance | 19 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0020 |
| Policy instance | 20 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0016 |
| Policy instance | 16 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0015 |
| Policy instance | 15 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0014 |
| Policy instance | 14 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0012 |
| Policy instance | 13 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0010 |
| Policy instance | 11 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0009 |
| Policy instance | 10 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0005 |
| Policy instance | 7 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0004 |
| Policy instance | 6 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0002 |
| Policy instance | 5 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0001 |
| Policy instance | 4 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 036-7522-00 |
| Policy instance | 3 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05575995 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 52830 |
| Policy instance | 1 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0007 |
| Policy instance | 9 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0008 |
| Policy instance | 10 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0009 |
| Policy instance | 11 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0020 |
| Policy instance | 21 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0019 |
| Policy instance | 20 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0018 |
| Policy instance | 19 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0017 |
| Policy instance | 18 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0016 |
| Policy instance | 17 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0015 |
| Policy instance | 16 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0014 |
| Policy instance | 15 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0012 |
| Policy instance | 14 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0011 |
| Policy instance | 13 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0010 |
| Policy instance | 12 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00248019/0006 |
| Policy instance | 8 |
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