1. No category

Member ID: 123456789
Member:
SUBSCRIBER FULLPOP
FIRSTNAME LASTNAME
Copays:
DOI-0508
Mailing/Meter Date:
UnitedHealthcare
Individual Exchanges
PO Box 30490
Salt Lake City UT 84130-049
PCP:
Important: Please register at myuhc.com to
view your coverage and manage claims.
Office: $30
>000001 9310565 003082
SUBSCRIBER FULLPOP
111 MAIN ST.
ANYTOWN ST 12345-6789
03082 9310565 0000 0000001 0000001 269 8 117
Health Plan (80840)
911-87726-04
Group Number:
PCP Phone: (999) 999-9999
Rx Bin:
Rx PCN:
RX Grp:
Spec: $60
Hlth Ins Mktplce offered in KY
Gold Compass 0
Payer ID 87726
Members: We're here to help. Check benefits, view claims, find a doctor, ask a
question and more. PCP to send electronic referrals.
Web:
www.myuhc.com
Call anytime to speak
myNurseLine: 877-257-7087
with a Nurse
800-642-9565
Phone:
610279
9999
UHEALTH
Providers:
877-842-3210 or www.UnitedHealthcareOnline.com
Medical Claims: PO Box 740800, Atlanta GA 30374-0800
Shipper ID: 00000000
Shipping Method: 2ND DAY
CARRIER: UPS
Address:
TO: SourceHOV, Inc.
SourceHOV, Inc.
ATTN: Jake Camp-St Exchng Processing
4050 South 500 West
Salt Lake City, UT 84123
904958
Underwritten by [Appropriate Legal Entity]
Referrals Required
UnitedHealthcare Compass
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Pharmacists: 888-290-5416
Pharmacy Claims: OptumRx PO Box 29044 Hot Springs, AR 71903
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Cycle Date: 20150926
PDF Date: Sat Sep 26, 2015 @ 14:40:14
MaxMover: N
UHG JOB ID: 8378 GRP: 0904958 PV: 0001 RC: 0001 MKT: 77777
MT: 37 SA: 00 OI: 01 FORM: K20001 CPAY: B INTL ID:
DALE BROWN: NO LTR: STOCK ID : STAN
TEMPLATE: ADV4MESTAN : STD IND : STANDARD : STANDARD
RSN CD:
Esta tarjeta es sólo para propósitos de identificación. No es prueba de membresía y no
garantiza cobertura.
This card is for identification only. It is not proof of membership and it does not guarantee
coverage.
Encontrará información y herramientas personalizadas para ayudarle a
administrar sus reclamos y ver cuánto adeuda, encontrar un médico u
hospital, calcular sus costos de atención de la salud, investigar temas de
salud, y encontrar respuestas a sus preguntas de atención de la salud.
Para obtener más ayuda o información, llámenos al número que se
encuentra en el reverso de su tarjeta, o vaya a uhclatino.com.
Gracias por elegirnos como proveedor de su plan de beneficios de
atención de la salud. Adjuntamos su tarjeta de identificación del plan de
salud de UnitedHealthcare. Empiece a usarla el día en que comience su
cobertura. Administre su atención de la salud en línea en myuhc.com.
We're here to help. If you have questions, visit myuhc.com or call the toll-free
member phone number on your ID card. TTY users can dial 711.
Sign up for myuhc.com7 and download the UnitedHealthcare Health4Me7
mobile app to find tools and information to help you manage your health and
benefits at home and on the go. You can find network doctors, track and pay
claims, estimate costs, and more. You can even view, download or print a
copy of your ID card.
Your UnitedHealthcare health plan identification (ID) card is attached. Please
check your card to be sure all information is correct. If not, please let us know
by calling the member number on the card. You may begin using your card
on your effective date. Remember to take your ID card to your appointments
and have it ready if you call us with questions.
Thank you for being a UnitedHealthcare member! We are proud to serve you.
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20150926
DIG1CARD
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SUBSCRIBER
HCAC/Medical
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14:40:14
,SUBSCRIBER
*117*
Printed: 09/26/15