State of Michigan employee forms

What you’ll need to complete these forms:

  • Enrollee ID card
  • A prescription from your doctor
  • A copier or scanner to make copies of receipts for you to keep
  • A printer to print the form
  • An envelope and postage to mail the form

If you have any questions, call the number on the back of your enrollee ID card and we'll help.

Forms

You can request a reimbursement if you had to pay an out of network doctor. You can fill out a State of Michigan claim form to ask us to pay for medical, hearing and vision services.

You can continue health care coverage for your child older than age 19 with a developmental or physical disability, if your child meets the State’s criteria. To apply for continued coverage, fill out the State Health Plan Disabled Dependent Application (PDF).