Enclosed are the Michigan Selection of Personal Injury Protection Allowable Expenses Coverage Form and the Michigan Bodily Injury Liability Coverage Form. These forms indicate your current Personal Injury Protection Allowable Expenses (PIP AE) and Bodily Injury (BI) coverage limits, which will continue to apply to your Meemic auto insurance policy at renewal if you timely confirm your coverage selections using the instructions provided below. Please review the information below to determine which forms you must return to Meemic using the enclosed postage-paid envelope. Please also be advised that the State default coverage limits for PIP AE* and $250,000 per person/$500,000 per accident (or higher) BI limits will be applied to your policy at renewal if you do not timely submit the required form(s) and/or Qualified Health Coverage proof(s) to Meemic.**

• You will need to complete and timely submit the enclosed Michigan Selection of Personal Injury Protection Allowable Expenses Coverage Form and the Michigan Bodily Injury Liability Coverage Form to Meemic.

• If your current PIP AE coverage is Option 1 (Unlimited), Option 2 ($500,000), or Option 3 ($250,000 with no excluded persons) and your current BI coverage limits are $250,000 per person/$500,000 per accident or higher, and you would like to keep the same coverages at renewal, all you need to do is timely pay your renewal bill. 
• If your current PIP AE coverage is Option 4 ($250,000 with some or all persons excluded), Option 5 ($50,000), or Option 6 (No PIP allowable expenses coverage) and you would like to keep the same PIP AE coverage at renewal, you will need to complete and timely submit the Michigan Selection of Personal Injury Protection Allowable Expenses Coverage Form to Meemic. Proof of Qualified Health Coverage (QHC) is required for some PIP AE coverage limit selections.*** Please review the information below for instructions on how to complete this form and which PIP AE coverage limit selections require submission of QHC proof(s). 
• If your current BI coverage limits are $50,000 per person/$100,000 per accident or $100,000 per person/$300,000 per accident, and you would like to keep the same BI coverage limits at renewal, you will need to complete and timely submit the Michigan Bodily Injury Liability Coverage Form to Meemic. Please review the information below for instructions on how to complete this form.

If you wish to change your PIP AE and/or BI coverage limits, please contact your Meemic representative.

If you would like to keep your current PIP AE coverage of Option 4 ($250,000 with some or all persons excluded), Option 5 ($50,000), or Option 6 (No PIP allowable expenses coverage) at renewal, you must complete the Michigan Selection of Personal Injury Protection Allowable Expenses Coverage Form. Please thoroughly review each section below to understand the PIP AE options and which PIP AE coverage limit selections require submission of QHC proof(s).
 
The PIP AE options that require completion of the form and submission of QHC proof(s) are:

• $250,000 Per Person Per Accident With Some or All Persons Excluded (SECTION A: OPTION 4)
• $50,000 Per Person Per Accident (SECTION A: OPTION 5)
• No PIP Allowable Expenses Coverage (SECTION A: OPTION 6)

You must initial and sign the Michigan Selection of Personal Injury Protection Allowable Expenses Coverage Form and provide the corresponding required QHC proof(s) if you wish to keep one of the above three PIP AE coverage limits. Please follow the below instructions on how to complete this form.

Under Section B: PIP Allowable Expenses Coverage Options and Certification

• Read and place your initials next to the “X” that shows your selected PIP AE limit.

Under Section D: Certification

• Read and place your initials next to the “X” on all four certifications.
• Sign and date the form in the designated area at the bottom of the page.

Please refer to the Medical Coverage Proof Requirements document enclosed to determine which QHC proof(s) your selected limit requires you to submit.

If you wish to change your PIP AE coverage limits, please contact your Meemic representative.

If you would like to keep your current BI coverage limits of $50,000 per person/$100,000 per accident or $100,000 per person/$300,000 per accident at renewal, you must complete the Michigan Bodily Injury Liability Coverage Form. Please follow the below instructions on how to complete this form:

• On Page 1, your current BI coverage limit choice has an “X” next to your selected limit.
• On Page 2, initial all 3 sections of Part C, and sign and date the form in the designated area at the bottom of the page.
• Return both pages in the provided postage-paid envelope.

If you wish to change your BI coverage limits, please contact your Meemic representative.

Return all pages of each form to Meemic in the enclosed postage-paid envelope. Include copies of all required QHC proof(s) in the enclosed postage-paid envelope or email them to Medproof@meemic.com. Include your policy number on all QHC proof documents.

Your policy will not be updated until all necessary forms are completed and approved, and all required proof(s) are received by Meemic. Any incomplete forms or missing information will result in delays for updates to your policy. Your required PIP AE forms, QHC proof(s), and BI forms must be returned to Meemic and processed before your policy renewal date, or the State default coverages of Unlimited PIP AE* and $250,000 per person/$500,000 per accident (or higher) BI limits will be applied to your policy at renewal, which may affect your premium.

Please contact your Meemic representative if you need additional help completing the forms or providing the required documentation.