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BEM 101 6 of 15 MA DESK AIDS BPB 2017-008 4-1-2017

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Medical Insurance Code Description 00 None Known (initial Value) 01 Aetna US Healthcare 02 American Association of Retired Persons (AARP) 03 American Community Mutual 04 Bankers 05 Blue Cross/Blue Shield of Michigan, Blue Cross/Blue Shield Federal and Blue Cross/Blue Shield - Other States 06 Benefit Services 07 Connecticut General Life and Equitable Life (aka CIGNA or Equicor) 08 CAN 09 General American 10 Wausau Insurance 11 Benefit Source 12 Reserved for future use 13 Great West Life/The New England 14 American Medical Security 15 Pyramid Life Insurance Company/The One Benefit Source 16 Unicare (aka John Hancock Mutual Life and Massachusetts Mutual)

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Page 6

Official source

BEM 101 6 of 15 MA DESK AIDS BPB 2017-008 4-1-2017

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Medical Insurance Code Description 00 None Known (initial Value) 01 Aetna US Healthcare 02 American Association of Retired Persons (AARP) 03 American Community Mutual 04 Bankers 05 Blue Cross/Blue Shield of Michigan, Blue Cross/Blue Shield Federal and Blue Cross/Blue Shield - Other States 06 Benefit Services 07 Connecticut General Life and Equitable Life (aka CIGNA or Equicor) 08 CAN 09 General American 10 Wausau Insurance 11 Benefit Source 12 Reserved for future use 13 Great West Life/The New England 14 American Medical Security 15 Pyramid Life Insurance Company/The One Benefit Source 16 Unicare (aka John Hancock Mutual Life and Massachusetts Mutual)