Schedule M1 Claims Repricing Active FY2024.xlsx
XLSX spreadsheet 2 MB Posted
- Solicitation number
- RFP 171 260000002410 2
- Issued by
- Michigan
About this file
This document is Schedule M1 claims repricing data for the State of Michigan's Request for Proposal No. 260000002410 regarding Behavioral Health and Substance Abuse Benefits for the State Health Plan PPO. The file contains historical claim information for active employees, spouses, and dependents during the period January 1, 2024 through December 31, 2024, organized across multiple service categories: inpatient hospital services, residential treatment facilities, day treatment programs, outpatient psychiatric and substance abuse services, intensive outpatient programs, and professional services. Bidders are instructed to complete the repricing exercise by providing allowed amounts based on their fee schedules as of January 1, 2028, and designating network status for each provider using specified codes (IC for in-network contracted, OC for out-of-network contracted, IX for in-network non-contracted, or OX for out-of-network non-contracted). The document explicitly prohibits bidders from marking any provider as "IC" if that provider's contract status is unknown due to ongoing negotiations scheduled to terminate on or after January 1, 2028.
The claims repricing data encompasses hundreds of providers across multiple states, with eligible billed charges ranging from nominal amounts to over $600,000 for specific service lines and patient categories. Significant providers in the network include Pine Rest Christian Mental Health Services in Grand Rapids, Edward W. Sparrow Hospital Association in Lansing, Henry Ford Health System locations, Regents of the University of Michigan, and numerous residential and day treatment facilities located both within and outside Michigan. The file serves as the baseline dataset for bid evaluation, allowing the State to assess each bidder's proposed network composition, reimbursement rates, and coverage adequacy based on historical utilization patterns. Bidders must not modify or resort the provided claim data in columns A through H, ensuring standardized response formatting for comparative analysis.
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Document Cover
| STATE OF MICHIGAN |
| Request For Proposal No. 260000002410 |
| Behavioral Health and Substance Abuse Benefits for the State Health Plan PPO |
| Schedule M1, Claims Repricing Active FY2024 |
Group: ACTIVE
Claim Paid Period: 01/01/24 - 12/31/24
Table of Contents
| Tab | |
| 1 | Definitions |
2 Inpatient
3 Residential Treatment
4 Day Treatment
5 Outpatient
6 Intensive Outpatient Program (IOP)
| 7 | Professional Services |
| Instructions: | |
| Allowed claims paid for each place of service are summarized by TIN, then CPT/Revenue code, and then relationship status. Bidder must provide the Allowed amount in column I and Network Status in column J based the provided eligible claim amounts, provider, CPT/Revenue code information, and Bidder's fee schedule as of 01/01/2028. Definitions for network status can be found on the "Definitions" tab. Bidder must not respond "IC" to any providers that will be terminating on or after 1/1/2028, which are under contract negotiations currently and for which the network status outcome of the contract negotiations is unknown. |
Bidder must not alter columns A through J or sort the information
Definitions Definitions:
· Inpatient Hospital Services – Services related only to the hospital or free standing facility charges of an acute inpatient stay.
· Residential Services – Services related only to the Non-hospital or free standing facility charges of a longer term live-in treatment facility.
· Day Treatment Services – Services related only to the delivery of day treatment regardless of setting.
· Outpatient Services – Psychiatric, psychological and substance abuse treatment expenses for providers who have direct contact with a patient. Includes medication management, psychological and substance abuse treatment from qualified providers.
· Intensive Outpatient Program Services – Services provided for 2-3 hours at a time, several days a week in a non-office setting.
· Professional Services – Provider services while the member is inpatient or in residential treatment (higher level of care).
· Eligible Billed Charges – Defined as the amount billed by the provider for benefits eligible for payment under the benefit contract. The Eligible Billed Charges exclude any duplicate claims or disallowed benefits. Claims that are not processed to determine the payment to be made to the provider (e.g. COB claims, bundled/unbundled charges) are excluded from Eligible Billed Charges.
· TIN – Provide the TIN and name of the specific provider rendering the service, even if the physician is part of a larger group practice.
| · Network Status - Please use the following codes in the "network status" response field to indicate if the provider is in the network you are proposing as of 01/01/28: |
| Note - Bidder must not respond "IC" to any providers that will be terminating on or after 1/1/2028, which are under contract negotiations currently and for which the network status outcome of the contract negotiations is unknown. |
| 1. "IC" - In Network Contracted: Use this code for providers with which you have a direct contract and that pay at the in-network level for members |
| 2. "OC" - Out of Network Contracted: Use this code for providers with which you have a secondary contract through a wrap network (or "shared savings" arrangement) and pay at the out-of-network level for members |
| 3. "IX" - In Network Non-Contracted: Use this code for providers with which you do not have a primary or secondary contract, but that pay at the in-network level for members. These types of providers would commonly include "non-member choice" providers such as hospital-based providers including radiologists, pathologists, anesthesiologists, etc. This category might also include ambulatory care and/or dialysis facilities. |
| 4. "OX" - Out of Network Non-Contracted: Use this code for providers which you do not have a primary or secondary contract, and pay at the out-of-network level for members. |
| 5. "OX" - Out of Network Non-Contracted: Use this code for providers which you do not have a primary or secondary contract, and pay at the out-of-network level for members. |
· Provider City, State and Zip Code – Provider information should align with place of service and not billing address
· Allowed Amount – Represents the negotiated reimbursement amount for covered services before member cost sharing (e.g., deductible, copayment, or coinsurance). Amount to be populated by bidders which is based on the 01/01/28 fee schedule.
&F&A
Inpatient
| Active claims paid 01/01/24 - 12/31/24 - Inpatient | |||||||||
| Claim information is summarized by Provider, then CPT/Revenue Code, and then Relationship Status (employee / spouse / depdendent). Provider information aligns with place of service and not billing address. | |||||||||
| Inpatient Services | |||||||||
| TIN | Provider Name | Provider City | Provider State | Provider Zip Code | CPT/Revenue Code | Relationship Status (employee/ spouse/ dependent (child) | Eligible to be Billed | Allowed Amount - Based on 01/01/28 fee schedule | Network Status |
IC, OC, IX, OX
| 043232990 | PHC OF MICHIGAN LLC | NEW BALTIMORE | MI | 48047 | 0124 | Dependent | $440,100.00 |
| 043232990 | PHC OF MICHIGAN LLC | NEW BALTIMORE | MI | 48047 | 0124 | Subscriber | $21,600.00 |
| 223682760 | RIVEREDGE HOSPITAL INC | FOREST PARK | IL | 60130 | 0124 | Dependent | $26,280.00 |
| 223682760 | RIVEREDGE HOSPITAL INC | FOREST PARK | IL | 60130 | 0250 | Dependent | $1,528.77 |
| 223682760 | RIVEREDGE HOSPITAL INC | FOREST PARK | IL | 60130 | 0300 | Dependent | $480.59 |
| 232285657 | FOREST VIEW PSYCHIATRIC HOSPITAL INC | GRAND RAPIDS | MI | 49546 | 0124 | Dependent | $272,700.00 |
| 232285657 | FOREST VIEW PSYCHIATRIC HOSPITAL INC | GRAND RAPIDS | MI | 49546 | 0124 | Spouse | $28,800.00 |
| 232983574 | UHS OF HARTGROVE INC | CHICAGO | IL | 60644 | 0124 | Dependent | $20,440.00 |
| 232983574 | UHS OF HARTGROVE INC | CHICAGO | IL | 60644 | 0250 | Dependent | $132.10 |
| 232983574 | UHS OF HARTGROVE INC | CHICAGO | IL | 60644 | 0300 | Dependent | $353.88 |
| 261175128 | EATING RECOVERY CENTER, LLC | DENVER | CO | 80230 | 0124 | Dependent | $176,880.00 |
| 262512084 | OAKLAND PHYSICIANS MEDICAL CENTER, LLC | PONTIAC | MI | 48341 | 0124 | Dependent | $25,074.00 |
| 262512084 | OAKLAND PHYSICIANS MEDICAL CENTER, LLC | PONTIAC | MI | 48341 | 0250 | Dependent | $188.15 |
| 262512084 | OAKLAND PHYSICIANS MEDICAL CENTER, LLC | PONTIAC | MI | 48341 | 0251 | Dependent | $171.70 |
| 263333652 | BCA OF DETROIT, LLC | DETROIT | MI | 48205 | 0124 | Dependent | $153,900.00 |
| 263333652 | BCA OF DETROIT, LLC | DETROIT | MI | 48205 | 0124 | Spouse | $70,200.00 |
| 264314533 | PSJ ACQUISITION LLC | FARGO | ND | 58103 | 0124 | Dependent | $2,185.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0123 | Dependent | $2,609.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0250 | Dependent | $106.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0260 | Dependent | $440.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0300 | Dependent | $1,404.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0301 | Dependent | $1,222.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0351 | Dependent | $3,360.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0450 | Dependent | $3,544.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0730 | Dependent | $302.00 |
| 272845064 | VHS CHILDRENS HOSPITAL OF MICHIGAN INC | DETROIT | MI | 48201 | 0740 | Dependent | $13,569.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0124 | Dependent | $58,563.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0250 | Dependent | $4,039.80 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0300 | Dependent | $155.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0301 | Dependent | $2,076.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0302 | Dependent | $555.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0305 | Dependent | $134.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0370 | Dependent | $2,118.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0611 | Dependent | $2,211.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0636 | Dependent | $360.80 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0710 | Dependent | $726.00 |
| 340714618 | FAIRVIEW HOSPITAL | CLEVELAND | OH | 44111 | 0730 | Dependent | $287.00 |
| 340967014 | MEDICAL UNIVERSITY OF OHIO AT TOLEDO | TOLEDO | OH | 43614 | 0114 | Dependent | $12,928.00 |
| 340967014 | MEDICAL UNIVERSITY OF OHIO AT TOLEDO | TOLEDO | OH | 43614 | 0250 | Dependent | $403.88 |
| 340967014 | MEDICAL UNIVERSITY OF OHIO AT TOLEDO | TOLEDO | OH | 43614 | 0300 | Dependent | $23.00 |
| 340967014 | MEDICAL UNIVERSITY OF OHIO AT TOLEDO | TOLEDO | OH | 43614 | 0301 | Dependent | $370.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0124 | Dependent | $24,360.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0124 | Subscriber | $38,976.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0250 | Dependent | $133.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0250 | Subscriber | $149.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0260 | Subscriber | $443.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0300 | Subscriber | $1,034.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0301 | Subscriber | $1,347.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0305 | Subscriber | $324.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0306 | Subscriber | $2,654.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0307 | Subscriber | $233.00 |
| 344428256 | THE TOLEDO HOSPITAL | TOLEDO | OH | 43606 | 0450 | Subscriber | $3,404.00 |
| 344446484 | DEFIANCE HOSPITAL INC. | DEFIANCE | OH | 43512 | 0124 | Subscriber | $7,797.00 |
| 344446484 | DEFIANCE HOSPITAL INC. | DEFIANCE | OH | 43512 | 0250 | Subscriber | $52.00 |
| 344446484 | DEFIANCE HOSPITAL INC. | DEFIANCE | OH | 43512 | 0300 | Subscriber | $21.00 |
| 344446484 | DEFIANCE HOSPITAL INC. | DEFIANCE | OH | 43512 | 0301 | Subscriber | $422.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0114 | Dependent | $23,650.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0114 | Spouse | $14,373.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0114 | Subscriber | $6,144.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0250 | Dependent | $240.11 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0250 | Spouse | $697.47 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0250 | Subscriber | $185.64 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0258 | Dependent | $114.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0258 | Spouse | $228.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0300 | Dependent | $13.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0300 | Spouse | $13.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0300 | Subscriber | $13.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0301 | Dependent | $1,698.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0301 | Spouse | $1,633.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0301 | Subscriber | $708.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0305 | Dependent | $229.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0305 | Spouse | $116.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0305 | Subscriber | $48.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0306 | Dependent | $646.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0306 | Subscriber | $150.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0307 | Dependent | $152.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0307 | Spouse | $37.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0351 | Spouse | $1,181.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0450 | Dependent | $2,603.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0450 | Spouse | $3,473.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0450 | Subscriber | $970.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0730 | Dependent | $218.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0730 | Spouse | $464.00 |
| 380833014 | MYMICHIGAN MEDICAL CENTER MIDLAND | MIDLAND | MI | 48670 | 0780 | Dependent | $87.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0110 | Subscriber | $1,889.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0250 | Subscriber | $1,101.89 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0255 | Subscriber | $127.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0260 | Subscriber | $1,223.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0300 | Subscriber | $14.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0301 | Subscriber | $2,016.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0305 | Subscriber | $160.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0306 | Subscriber | $100.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0351 | Subscriber | $1,727.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0352 | Subscriber | $2,004.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0402 | Subscriber | $710.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0421 | Subscriber | $213.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0424 | Subscriber | $402.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0431 | Subscriber | $251.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0434 | Subscriber | $292.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0450 | Subscriber | $1,949.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0730 | Subscriber | $382.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0762 | Subscriber | $1,924.00 |
| 380997730 | MYMICHIGAN MEDICAL CENTER SAGINAW | SAGINAW | MI | 48601 | 0925 | Subscriber | $43.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0200 | Subscriber | $28,816.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0250 | Subscriber | $4,459.83 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0258 | Subscriber | $838.86 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0260 | Subscriber | $4,479.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0270 | Subscriber | $216.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0272 | Subscriber | $160.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0301 | Subscriber | $4,044.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0302 | Subscriber | $86.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0305 | Subscriber | $549.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0306 | Subscriber | $659.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0307 | Subscriber | $73.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0320 | Subscriber | $376.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0324 | Subscriber | $1,065.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0410 | Subscriber | $7,571.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0421 | Subscriber | $105.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0424 | Subscriber | $267.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0431 | Subscriber | $210.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0434 | Subscriber | $301.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0450 | Subscriber | $6,745.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0730 | Subscriber | $294.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0761 | Subscriber | $588.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | DETROIT | MI | 48202 | 0920 | Subscriber | $1,179.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | WEST BLOOMFIELD | MI | 48322 | 0124 | Dependent | $34,722.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | WEST BLOOMFIELD | MI | 48322 | 0250 | Dependent | $890.12 |
| 381357020 | HENRY FORD HEALTH SYSTEM | WEST BLOOMFIELD | MI | 48322 | 0301 | Dependent | $1,592.00 |
| 381357020 | HENRY FORD HEALTH SYSTEM | WEST BLOOMFIELD | MI | 48322 | 0305 | Dependent | $92.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0120 | Spouse | $28,392.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0120 | Subscriber | $12,376.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0250 | Spouse | $979.82 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0250 | Subscriber | $2,242.42 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0301 | Spouse | $1,508.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0301 | Subscriber | $713.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0302 | Spouse | $302.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0302 | Subscriber | $151.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0305 | Spouse | $106.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0305 | Subscriber | $46.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0306 | Spouse | $740.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0306 | Subscriber | $62.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0307 | Subscriber | $39.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0320 | Subscriber | $247.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0900 | Spouse | $351.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0900 | Subscriber | $351.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0914 | Spouse | $2,455.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0914 | Subscriber | $866.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0915 | Spouse | $7,186.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0915 | Subscriber | $1,914.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0960 | Spouse | $656.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0960 | Subscriber | $656.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0988 | Spouse | $1,230.00 |
| 381357020 | HENRY FORD MAPLEGROVE CENTER | WEST BLOOMFIELD | MI | 48322 | 0988 | Subscriber | $440.00 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0124 | Dependent | $34,505.85 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0124 | Spouse | $20,744.10 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0124 | Subscriber | $6,896.25 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0250 | Dependent | $1,528.60 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0250 | Spouse | $659.08 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0250 | Subscriber | $173.68 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0252 | Dependent | $2,553.96 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0252 | Spouse | $1,175.04 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0300 | Dependent | $4,628.75 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0300 | Spouse | $3,625.50 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0300 | Subscriber | $2,981.00 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0301 | Dependent | $1,429.75 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0301 | Spouse | $605.50 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0301 | Subscriber | $1,127.00 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0305 | Dependent | $250.50 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0305 | Subscriber | $250.50 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0307 | Dependent | $204.25 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0307 | Subscriber | $49.00 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0450 | Dependent | $5,388.01 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0450 | Subscriber | $3,106.75 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0636 | Subscriber | $32.76 |
| 381358208 | MEMORIAL HOSPITAL | OWOSSO | MI | 48867 | 0730 | Subscriber | $280.50 |
| 381358212 | HENRY FORD HEALTH PROVIDENCE HOSPITAL | NOVI | MI | 48374 | 0206 | Spouse | $8,216.00 |
| 381358212 | HENRY FORD HEALTH PROVIDENCE HOSPITAL | NOVI | MI | 48374 | 0260 | Spouse | $160.00 |
| 381358212 | HENRY FORD HEALTH PROVIDENCE HOSPITAL | NOVI | MI | 48374 | 0450 | Spouse | $2,699.00 |
| 381358212 | HENRY FORD HEALTH PROVIDENCE HOSPITAL | NOVI | MI | 48374 | 0483 | Spouse | $3,390.00 |
| 381358410 | LUTHERAN HOMES OF MICHIGAN, INC. | FRANKENMUTH | MI | 48734 | 0120 | Subscriber | $4,875.00 |
| 381358410 | LUTHERAN HOMES OF MICHIGAN, INC. | FRANKENMUTH | MI | 48734 | 0300 | Subscriber | $18.38 |
| 381358410 | LUTHERAN HOMES OF MICHIGAN, INC. | FRANKENMUTH | MI | 48734 | 0420 | Subscriber | $1,600.00 |
| 381358410 | LUTHERAN HOMES OF MICHIGAN, INC. | FRANKENMUTH | MI | 48734 | 0424 | Subscriber | $100.00 |
| 381358410 | LUTHERAN HOMES OF MICHIGAN, INC. | FRANKENMUTH | MI | 48734 | 0430 | Subscriber | $1,900.00 |
| 381358410 | LUTHERAN HOMES OF MICHIGAN, INC. | FRANKENMUTH | MI | 48734 | 0434 | Subscriber | $100.00 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0110 | Dependent | $9,873.06 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0120 | Dependent | $3,291.02 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0250 | Dependent | $1,271.74 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0258 | Dependent | $399.16 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0270 | Dependent | $883.04 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0300 | Dependent | $261.10 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0301 | Dependent | $1,293.40 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0305 | Dependent | $118.11 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0351 | Dependent | $2,968.90 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0450 | Dependent | $4,757.43 |
| 381359087 | BRONSON METHODIST HOSPITAL | KALAMAZOO | MI | 49007 | 0740 | Dependent | $2,436.23 |
| 381359247 | HENRY FORD HEALTH ROCHESTER HOSPITAL | ROCHESTER | MI | 48307 | 0124 | Dependent | $26,950.00 |
| 381359247 | HENRY FORD HEALTH ROCHESTER HOSPITAL | ROCHESTER | MI | 48307 | 0250 | Dependent | $1,151.75 |
| 381359247 | HENRY FORD HEALTH ROCHESTER HOSPITAL | ROCHESTER | MI | 48307 | 0300 | Dependent | $42.00 |
| 381359247 | HENRY FORD HEALTH ROCHESTER HOSPITAL | ROCHESTER | MI | 48307 | 0301 | Dependent | $22.00 |
| 381360526 | ASCENSION BORGESS HOSPITAL | KALAMAZOO | MI | 49048 | 0124 | Dependent | $6,470.00 |
| 381360526 | ASCENSION BORGESS HOSPITAL | KALAMAZOO | MI | 49048 | 0250 | Dependent | $250.56 |
| 381360526 | ASCENSION BORGESS HOSPITAL | KALAMAZOO | MI | 49048 | 0260 | Dependent | $1,560.00 |
| 381360526 | ASCENSION BORGESS HOSPITAL | KALAMAZOO | MI | 49048 | 0301 | Dependent | $535.89 |
| 381360526 | ASCENSION BORGESS HOSPITAL | KALAMAZOO | MI | 49048 | 0305 | Dependent | $95.00 |
| 381360526 | ASCENSION BORGESS HOSPITAL | KALAMAZOO | MI | 49048 | 0450 | Dependent | $3,195.00 |
| 381360526 | ASCENSION BORGESS HOSPITAL | KALAMAZOO | MI | 49048 | 0914 | Dependent | $402.00 |
| 381360526 | ASCENSION BORGESS HOSPITAL | KALAMAZOO | MI | 49048 | 0919 | Dependent | $320.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0114 | Dependent | $35,000.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0123 | Dependent | $9,284.42 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0250 | Dependent | $782.11 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0300 | Dependent | $54.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0301 | Dependent | $1,242.03 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0302 | Dependent | $160.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0305 | Dependent | $77.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0320 | Dependent | $225.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0450 | Dependent | $3,202.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0681 | Dependent | $3,718.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0730 | Dependent | $151.00 |
| 381360529 | SPECTRUM HEALTH HOSPITALS | GRAND RAPIDS | MI | 49503 | 0740 | Dependent | $2,725.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0121 | Spouse | $17,718.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0121 | Subscriber | $23,624.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0201 | Dependent | $6,818.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0206 | Spouse | $14,904.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0206 | Subscriber | $39,744.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0250 | Dependent | $1,045.89 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0250 | Spouse | $10,216.85 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0250 | Subscriber | $10,918.06 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0255 | Spouse | $300.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0255 | Subscriber | $920.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0260 | Spouse | $5,056.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0260 | Subscriber | $12,394.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0270 | Dependent | $371.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0270 | Spouse | $371.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0270 | Subscriber | $1,222.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0274 | Dependent | $265.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0300 | Dependent | $39.06 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0300 | Spouse | $190.92 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0300 | Subscriber | $739.80 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0301 | Dependent | $1,250.46 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0301 | Spouse | $2,412.19 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0301 | Subscriber | $3,191.64 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0305 | Dependent | $155.04 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0305 | Spouse | $549.60 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0305 | Subscriber | $771.24 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0306 | Spouse | $979.62 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0307 | Spouse | $19.02 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0307 | Subscriber | $19.02 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0320 | Dependent | $388.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0324 | Dependent | $197.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0324 | Spouse | $394.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0324 | Subscriber | $197.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0351 | Subscriber | $2,178.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0352 | Spouse | $5,620.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0352 | Subscriber | $14,613.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0402 | Spouse | $770.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0410 | Dependent | $3,255.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0410 | Subscriber | $4,679.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0450 | Spouse | $4,280.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0450 | Subscriber | $6,420.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0611 | Dependent | $2,226.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0730 | Dependent | $204.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0730 | Spouse | $408.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0730 | Subscriber | $204.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0740 | Dependent | $2,144.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0771 | Subscriber | $107.00 |
| 381360584 | EDWARD W SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0921 | Spouse | $838.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0128 | Spouse | $36,694.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0250 | Spouse | $5,210.76 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0301 | Spouse | $579.60 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0305 | Spouse | $139.86 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0306 | Spouse | $855.78 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0421 | Spouse | $15,552.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0424 | Spouse | $668.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0431 | Spouse | $6,720.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0434 | Spouse | $668.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0441 | Spouse | $2,504.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48909 | 0444 | Spouse | $519.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0114 | Dependent | $7,578.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0124 | Dependent | $121,036.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0124 | Spouse | $8,898.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0124 | Subscriber | $65,252.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0134 | Dependent | $85,600.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0134 | Subscriber | $54,492.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0204 | Dependent | $19,401.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0250 | Dependent | $11,445.68 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0250 | Spouse | $780.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0250 | Subscriber | $7,289.69 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0260 | Dependent | $837.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0270 | Dependent | $371.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0300 | Dependent | $2,659.77 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0300 | Spouse | $163.32 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0300 | Subscriber | $537.42 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0301 | Dependent | $11,510.18 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0301 | Spouse | $752.26 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0301 | Subscriber | $3,664.32 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0302 | Dependent | $173.94 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0305 | Dependent | $752.10 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0305 | Spouse | $46.62 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0305 | Subscriber | $155.04 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0306 | Dependent | $4,672.65 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0306 | Spouse | $307.86 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0306 | Subscriber | $1,779.36 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0320 | Dependent | $388.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0351 | Dependent | $6,534.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0361 | Dependent | $534.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0450 | Dependent | $25,598.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0450 | Spouse | $2,140.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0450 | Subscriber | $8,191.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0682 | Dependent | $5,116.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0730 | Dependent | $2,236.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0730 | Spouse | $204.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0730 | Subscriber | $612.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0771 | Dependent | $107.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0914 | Dependent | $6,610.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0914 | Spouse | $577.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0914 | Subscriber | $2,732.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0915 | Dependent | $27,465.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0915 | Spouse | $1,155.00 |
| 381360584 | EDWARD W. SPARROW HOSPITAL ASSOCIATION | LANSING | MI | 48912 | 0915 | Subscriber | $23,941.00 |
| 381362830 | MUNSON MEDICAL CENTER | TRAVERSE CITY | MI | 49684 | 0124 | Dependent | $18,703.00 |
| 381362830 | MUNSON MEDICAL CENTER | TRAVERSE CITY | MI | 49684 | 0250 | Dependent | $301.95 |
| 381362830 | MUNSON MEDICAL CENTER | TRAVERSE CITY | MI | 49684 | 0300 | Dependent | $48.00 |
| 381362830 | MUNSON MEDICAL CENTER | TRAVERSE CITY | MI | 49684 | 0301 | Dependent | $923.00 |
| 381362830 | MUNSON MEDICAL CENTER | TRAVERSE CITY | MI | 49684 | 0305 | Dependent | $81.00 |
| 381362830 | MUNSON MEDICAL CENTER | TRAVERSE CITY | MI | 49684 | 0307 | Dependent | $95.00 |
| 381362830 | MUNSON MEDICAL CENTER | TRAVERSE CITY | MI | 49684 | 0450 | Dependent | $1,332.00 |
| 381368347 | ELLA E. M. BROWN CHARITABLE CIRCLE | MARSHALL | MI | 49068 | 0124 | Dependent | $36,900.00 |
| 381368347 | ELLA E. M. BROWN CHARITABLE CIRCLE | MARSHALL | MI | 49068 | 0124 | Spouse | $34,209.00 |
| 381368347 | ELLA E. M. BROWN CHARITABLE CIRCLE | MARSHALL | MI | 49068 | 0250 | Dependent | $40.65 |
| 381368347 | ELLA E. M. BROWN CHARITABLE CIRCLE | MARSHALL | MI | 49068 | 0250 | Spouse | $433.36 |
| 381368347 | ELLA E. M. BROWN CHARITABLE CIRCLE | MARSHALL | MI | 49068 | 0301 | Spouse | $27.00 |
| 381368347 | ELLA E. M. BROWN CHARITABLE CIRCLE | MARSHALL | MI | 49068 | 0305 | Spouse | $14.00 |
| 381368347 | ELLA E. M. BROWN CHARITABLE CIRCLE | MARSHALL | MI | 49068 | 0424 | Spouse | $272.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0114 | Dependent | $619,520.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0114 | Spouse | $49,000.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0114 | Subscriber | $139,345.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0124 | Dependent | $138,150.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0124 | Spouse | $4,900.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0124 | Subscriber | $110,250.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0126 | Dependent | $21,950.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0126 | Spouse | $24,370.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0126 | Subscriber | $33,337.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0250 | Dependent | $15,327.11 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0250 | Spouse | $1,447.69 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0250 | Subscriber | $7,861.73 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0300 | Dependent | $373.38 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0300 | Spouse | $83.06 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0300 | Subscriber | $345.52 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0301 | Dependent | $7,707.16 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0301 | Spouse | $921.70 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0301 | Subscriber | $1,846.44 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0302 | Dependent | $27.54 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0302 | Spouse | $207.69 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0305 | Dependent | $479.57 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0305 | Spouse | $105.84 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0305 | Subscriber | $389.93 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0306 | Dependent | $523.57 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0306 | Spouse | $373.56 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0307 | Dependent | $52.94 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0307 | Spouse | $20.76 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0730 | Dependent | $142.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0915 | Dependent | $2,582.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0915 | Spouse | $3,031.00 |
| 381368360 | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | GRAND RAPIDS | MI | 49548 | 0915 | Subscriber | $4,317.00 |
| 381369611 | MCLAREN PORT HURON | PORT HURON | MI | 48060 | 0124 | Dependent | $29,325.40 |
| 381369611 | MCLAREN PORT HURON | PORT HURON | MI | 48060 | 0250 | Dependent | $1,815.70 |
| 381369611 | MCLAREN PORT HURON | PORT HURON | MI | 48060 | 0300 | Dependent | $76.40 |
| 381369611 | MCLAREN PORT HURON | PORT HURON | MI | 48060 | 0301 | Dependent | $773.60 |
| 381369611 | MCLAREN PORT HURON | PORT HURON | MI | 48060 | 0305 | Dependent | $48.80 |
| 381369611 | MCLAREN PORT HURON | PORT HURON | MI | 48060 | 0307 | Dependent | $40.00 |
| 381369611 | MCLAREN PORT HURON | PORT HURON | MI | 48060 | 0450 | Dependent | $1,629.00 |
| 381369611 | MCLAREN PORT HURON | PORT HURON | MI | 48060 | 0636 | Dependent | $230.80 |
| 381428164 | MCLAREN OAKLAND | PONTIAC | MI | 48342 | 0124 | Dependent | $9,807.00 |
| 381428164 | MCLAREN OAKLAND | PONTIAC | MI | 48342 | 0250 | Dependent | $378.05 |
| 381428164 | MCLAREN OAKLAND | PONTIAC | MI | 48342 | 0301 | Dependent | $447.80 |
| 381428164 | MCLAREN OAKLAND | PONTIAC | MI | 48342 | 0305 | Dependent | $79.90 |
| 381428164 | MCLAREN OAKLAND | PONTIAC | MI | 48342 | 0771 | Dependent | $96.50 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0121 | Subscriber | $5,916.00 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0250 | Subscriber | $2,626.26 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0258 | Subscriber | $682.09 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0260 | Subscriber | $4,798.40 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0301 | Subscriber | $2,402.90 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0302 | Subscriber | $58.70 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0305 | Subscriber | $230.70 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0306 | Subscriber | $151.40 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0320 | Subscriber | $564.30 |
| 381434090 | MCLAREN GREATER LANSING | LANSING | MI | 48910 | 0450 | Subscriber | $1,994.00 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0114 | Dependent | $15,360.00 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0114 | Spouse | $6,388.00 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0114 | Subscriber | $35,134.00 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0250 | Dependent | $99.00 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0250 | Spouse | $84.64 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0250 | Subscriber | $779.47 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0301 | Subscriber | $5.00 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0302 | Subscriber | $72.00 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0306 | Subscriber | $48.00 |
| 381437919 | MYMICHIGAN MEDICAL CENTER ALMA | ALMA | MI | 48801 | 0307 | Subscriber | $115.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0120 | Subscriber | $7,500.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0123 | Dependent | $7,464.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0250 | Dependent | $460.08 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0250 | Subscriber | $368.02 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0260 | Dependent | $660.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0300 | Dependent | $531.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0301 | Dependent | $546.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0301 | Subscriber | $1,566.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0305 | Dependent | $60.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0305 | Subscriber | $200.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0307 | Dependent | $25.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0307 | Subscriber | $25.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0324 | Subscriber | $295.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0351 | Dependent | $2,099.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0351 | Subscriber | $2,099.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0352 | Subscriber | $2,191.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0450 | Dependent | $2,804.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0450 | Subscriber | $2,804.00 |
| 381459362 | WILLIAM BEAUMONT HOSPITAL | ROYAL OAK | MI | 48073 | 0740 | Dependent | $3,499.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0120 | Dependent | $7,840.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0120 | Spouse | $35,720.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0120 | Subscriber | $77,060.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0126 | Dependent | $2,100.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0126 | Spouse | $7,150.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0126 | Subscriber | $17,800.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0914 | Dependent | $375.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0914 | Spouse | $1,590.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0914 | Subscriber | $2,840.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0915 | Dependent | $1,050.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0915 | Spouse | $4,825.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0915 | Subscriber | $9,825.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0916 | Dependent | $125.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0916 | Spouse | $375.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0916 | Subscriber | $625.00 |
| 381576680 | HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY | BRIGHTON | MI | 48116 | 0942 | Subscriber | $75.00 |
| 381880385 | SACRED HEART REHABILITATION CENTER, INC. | RICHMOND | MI | 48062 | 0120 | Spouse | $7,600.00 |
| 381880385 | SACRED HEART REHABILITATION CENTER, INC. | RICHMOND | MI | 48062 | 0126 | Spouse | $1,500.00 |
| 381901104 | MADISON COMMUNITY HOSPITAL, INC. | DETROIT | MI | 48213 | 0124 | Dependent | $9,000.00 |
| 381901104 | MADISON COMMUNITY HOSPITAL, INC. | DETROIT | MI | 48213 | 0124 | Subscriber | $22,500.00 |
| 381901104 | MADISON COMMUNITY HOSPITAL, INC. | DETROIT | MI | 48213 | 0250 | Dependent | $12.58 |
| 381901104 | MADISON COMMUNITY HOSPITAL, INC. | DETROIT | MI | 48213 | 0250 | Subscriber | $38.36 |
| 381901104 | MADISON COMMUNITY HOSPITAL, INC. | DETROIT | MI | 48213 | 0251 | Subscriber | $4.02 |
| 381901104 | MADISON COMMUNITY HOSPITAL, INC. | DETROIT | MI | 48213 | 0300 | Dependent | $130.97 |
| 381901104 | MADISON COMMUNITY HOSPITAL, INC. | DETROIT | MI | 48213 | 0300 | Subscriber | $126.11 |
| 381961500 | COMMUNITY HEALING CENTER | KALAMAZOO | MI | 49048 | 0126 | Subscriber | $1,800.00 |
| 381961500 | COMMUNITY HEALING CENTER | KALAMAZOO | MI | 49048 | 0300 | Subscriber | $35.00 |
| 381961500 | COMMUNITY HEALING CENTER | KALAMAZOO | MI | 49048 | 0919 | Subscriber | $125.00 |
| 381961500 | COMMUNITY HEALING CENTER | KALAMAZOO | MI | 49048 | 0960 | Subscriber | $223.24 |
| 381976271 | MCLAREN BAY REGION | BAY CITY | MI | 48708 | 0124 | Dependent | $10,325.00 |
| 381976271 | MCLAREN BAY REGION | BAY CITY | MI | 48708 | 0124 | Subscriber | $10,325.00 |
| 381976271 | MCLAREN BAY REGION | BAY CITY | MI | 48708 | 0250 | Dependent | $517.06 |
| 381976271 | MCLAREN BAY REGION | BAY CITY | MI | 48708 | 0250 | Subscriber | $270.95 |
| 381976271 | MCLAREN BAY REGION | BAY CITY | MI | 48708 | 0301 | Dependent | $386.90 |
| 381976271 | MCLAREN BAY REGION | BAY CITY | MI | 48708 | 0305 | Dependent | $79.90 |
| 381984289 | MERCY MEMORIAL HOSPITAL CORPORATION | MONROE | MI | 48162 | 0124 | Dependent | $17,682.00 |
| 381984289 | MERCY MEMORIAL HOSPITAL CORPORATION | MONROE | MI | 48162 | 0250 | Dependent | $300.00 |
| 381984289 | MERCY MEMORIAL HOSPITAL CORPORATION | MONROE | MI | 48162 | 0301 | Dependent | $511.00 |
| 381984289 | MERCY MEMORIAL HOSPITAL CORPORATION | MONROE | MI | 48162 | 0771 | Dependent | $102.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0124 | Dependent | $36,624.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0124 | Subscriber | $27,141.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0250 | Dependent | $434.57 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0250 | Subscriber | $252.09 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0300 | Dependent | $15.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0300 | Subscriber | $29.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0301 | Dependent | $1,650.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0301 | Subscriber | $1,931.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0305 | Dependent | $224.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0305 | Subscriber | $112.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0306 | Dependent | $247.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0306 | Subscriber | $494.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0307 | Dependent | $110.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0307 | Subscriber | $110.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0450 | Dependent | $2,490.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0450 | Subscriber | $4,980.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0730 | Dependent | $209.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL | JACKSON | MI | 49201 | 0730 | Subscriber | $408.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL, INC. | JACKSON | MI | 49201 | 0129 | Dependent | $1,715.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL, INC. | JACKSON | MI | 49201 | 0250 | Dependent | $20.75 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL, INC. | JACKSON | MI | 49201 | 0258 | Dependent | $271.49 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL, INC. | JACKSON | MI | 49201 | 0301 | Dependent | $552.00 |
| 382027689 | W.A. FOOTE MEMORIAL HOSPITAL, INC. | JACKSON | MI | 49201 | 0305 | Dependent | $56.00 |
| 382233166 | COMMUNITY PROGRAMS INC. | WATERFORD | MI | 48327 | 0120 | Spouse | $3,500.00 |
| 382233166 | COMMUNITY PROGRAMS INC. | WATERFORD | MI | 48327 | 0126 | Spouse | $2,100.00 |
| 382233166 | COMMUNITY PROGRAMS INC. | WATERFORD | MI | 48327 | 0300 | Spouse | $28.00 |
| 382233166 | COMMUNITY PROGRAMS INC. | WATERFORD | MI | 48327 | 0914 | Spouse | $285.00 |
| 382233166 | COMMUNITY PROGRAMS INC. | WATERFORD | MI | 48327 | 0915 | Spouse | $408.00 |
| 382233166 | COMMUNITY PROGRAMS INC. | WATERFORD | MI | 48327 | 0919 | Spouse | $285.00 |
| 382383119 | MCLAREN FLINT | FLINT | MI | 48532 | 0124 | Dependent | $38,448.00 |
| 382383119 | MCLAREN FLINT | FLINT | MI | 48532 | 0124 | Subscriber | $9,612.00 |
| 382383119 | MCLAREN FLINT | FLINT | MI | 48532 | 0250 | Dependent | $959.85 |
| 382383119 | MCLAREN FLINT | FLINT | MI | 48532 | 0250 | Subscriber | $21.28 |
| 382383119 | MCLAREN FLINT | FLINT | MI | 48532 | 0301 | Dependent | $1,013.20 |
| 382383119 | MCLAREN FLINT | FLINT | MI | 48532 | 0301 | Subscriber | $517.00 |
| 382383119 | MCLAREN FLINT | FLINT | MI | 48532 | 0305 | Dependent | $224.20 |
| 382383119 | MCLAREN FLINT | FLINT | MI | 48532 | 0305 | Subscriber | $79.90 |
| 382409580 | HAVENWYCK HOSPITAL INC | AUBURN HILLS | MI | 48326 | 0134 | Dependent | $205,500.00 |
| 382409580 | HAVENWYCK HOSPITAL INC | AUBURN HILLS | MI | 48326 | 0134 | Spouse | $18,000.00 |
| 382409580 | HAVENWYCK HOSPITAL INC | AUBURN HILLS | MI | 48326 | 0134 | Subscriber | $10,500.00 |
| 382409580 | HAVENWYCK HOSPITAL INC | ST JOHNS | MI | 48879 | 0124 | Dependent | $488,000.00 |
| 382409580 | HAVENWYCK HOSPITAL INC | ST JOHNS | MI | 48879 | 0124 | Spouse | $32,000.00 |
| 382409580 | HAVENWYCK HOSPITAL INC | ST JOHNS | MI | 48879 | 0124 | Subscriber | $76,000.00 |
| 382453316 | GREAT LAKES RECOVERY CENTERS | MARQUETTE | MI | 49855 | 0120 | Dependent | $14,754.80 |
| 382453316 | GREAT LAKES RECOVERY CENTERS | MARQUETTE | MI | 49855 | 0120 | Spouse | $11,816.00 |
| 382453316 | GREAT LAKES RECOVERY CENTERS | MARQUETTE | MI | 49855 | 0120 | Subscriber | $8,440.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0114 | Dependent | $30,528.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0114 | Spouse | $13,568.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0124 | Dependent | $30,528.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0124 | Spouse | $6,784.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0124 | Subscriber | $25,879.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0250 | Dependent | $334.87 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0250 | Spouse | $95.20 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0250 | Subscriber | $99.96 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0260 | Spouse | $230.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0300 | Spouse | $392.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0301 | Dependent | $1,287.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0301 | Spouse | $2,125.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0301 | Subscriber | $617.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0302 | Dependent | $207.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0302 | Spouse | $343.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0302 | Subscriber | $69.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0305 | Dependent | $126.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0305 | Spouse | $104.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0305 | Subscriber | $315.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0307 | Spouse | $42.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0450 | Spouse | $1,816.00 |
| 382589966 | MERCY HEALTH PARTNERS | MUSKEGON | MI | 49442 | 0730 | Spouse | $153.00 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0124 | Dependent | $26,158.15 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0124 | Subscriber | $9,582.00 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0250 | Dependent | $370.62 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0250 | Subscriber | $4,999.64 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0301 | Dependent | $1,119.50 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0301 | Subscriber | $150.00 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0305 | Dependent | $192.45 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0306 | Dependent | $156.00 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0307 | Dependent | $93.30 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0309 | Dependent | $89.20 |
| 382602147 | MYMICHIGAN MEDICAL CENTER SAULT | KINCHELOE | MI | 49788 | 0780 | Dependent | $94.00 |
| 382689033 | MCLAREN LAPEER REGION | LAPEER | MI | 48446 | 0124 | Spouse | $8,760.00 |
| 382689033 | MCLAREN LAPEER REGION | LAPEER | MI | 48446 | 0250 | Spouse | $61.11 |
| 382689033 | MCLAREN LAPEER REGION | LAPEER | MI | 48446 | 0301 | Spouse | $336.80 |
| 382689033 | MCLAREN LAPEER REGION | LAPEER | MI | 48446 | 0302 | Spouse | $42.60 |
| 382791823 | HENRY FORD WYANDOTTE HOSPITAL | WYANDOTTE | MI | 48192 | 0124 | Spouse | $8,784.00 |
| 382791823 | HENRY FORD WYANDOTTE HOSPITAL | WYANDOTTE | MI | 48192 | 0124 | Subscriber | $8,784.00 |
| 382791823 | HENRY FORD WYANDOTTE HOSPITAL | WYANDOTTE | MI | 48192 | 0250 | Spouse | $167.87 |
| 382791823 | HENRY FORD WYANDOTTE HOSPITAL | WYANDOTTE | MI | 48192 | 0250 | Subscriber | $89.48 |
| 382791823 | HENRY FORD WYANDOTTE HOSPITAL | WYANDOTTE | MI | 48192 | 0300 | Spouse | $15.00 |
| 382791823 | HENRY FORD WYANDOTTE HOSPITAL | WYANDOTTE | MI | 48192 | 0300 | Subscriber | $15.00 |
| 382791823 | HENRY FORD WYANDOTTE HOSPITAL | WYANDOTTE | MI | 48192 | 0301 | Spouse | $131.00 |
| 382791823 | HENRY FORD WYANDOTTE HOSPITAL | WYANDOTTE | MI | 48192 | 0301 | Subscriber | $286.00 |
| 382796005 | EMMA L. BIXBY MEDICAL CENTER | ADRIAN | MI | 49221 | 0121 | Subscriber | $8,712.00 |
| 382796005 | EMMA L. BIXBY MEDICAL CENTER | ADRIAN | MI | 49221 | 0200 | Subscriber | $18,920.00 |
| 382796005 | EMMA L. BIXBY MEDICAL CENTER | ADRIAN | MI | 49221 | 0206 | Subscriber | $5,978.00 |
| 382796005 | EMMA L. BIXBY MEDICAL CENTER | ADRIAN | MI | 49221 | 0250 | Subscriber | $5,471.00 |
| 382796005 | EMMA L. BIXBY MEDICAL CENTER | ADRIAN | MI | 49221 | 0255 | Subscriber | $233.00 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .