Understanding your new ID card - UMR

1 Understanding your new ID card 2019 United HealthCare Services, Inc. UM0092-CC 1019 (FS0018)No part of this document may be reproduced without permission. Issuer (80840) 911-39026-02 Member ID: Group Number:Member:Dependents:SUSAN M SAMPLE 01 MED DEN VISC opays:Office $20 / Spec $405010 Administered by UMR Teladoc $1034376414038176-414038 JONATHON G SAMPLE 00 MED DEN VISI ssuer (80840) 911-39026-02 Member ID: Group Number:Member:Dependents:SUSAN M SAMPLE 01 MED DEN VISC opays:Office $20 / Spec $405010 Administered by UMR Teladoc $1034376414038176-414038 JONATHON G SAMPLE 00 MED DEN VIS03122 9590397 0000 0000290 0000282 277 6 116 03122 9590397 0000 0000290 0000282 277 6 116 RUN_DATE 20191005 17:48.

2 27 DATA_SEQ_NO 0000001 CLIENT_NUMBER 003122 UHG_TYPE DIG2 SHRTDOC_ID DOC_SEQ_ID 0000290 NAME SAMPLE ,JONATHONMAILSET_NUMBER 0000282 CUSTCPS_KEY1 343764140381343764140381_KEY0 CARD1 CUSTCPS_KEY1 343764140381343764140381_KEY0 CARD2 CUSTCPS_KEY2 76414038 CUSTCPS_KEY2 76414038 CUSTCPS_KEY3 JONATHONCUSTCPS_KEY3 JONATHONCUSTCPS_KEY4 HCAC/MedicalCUSTCPS_KEY4 HCAC/MedicalCUSTCPS_KEY5 00 CUSTCPS_KEY5 01 CUSTCPS_KEY5 00 CUSTCPS_KEY5 01 CUSTCPS_KEY6 20200101 CUSTCPS_KEY6 20200101 CUSTCPS_KEY7 343764140381~00 CARD1 CUSTCPS_KEY7 343764140381~01 CARD1 CUSTCPS_KEY7 343764140381~00 CARD2 CUSTCPS_KEY7 343764140381~01 CARD2 CUSTCPS_KEY8 343764140381 CUSTCPS_KEY8 343764140381 CUSTCPS_KEY9 343764140381~00 CARD1 CUSTCPS_KEY9 343764140381~01 CARD1 CUSTCPS_KEY9 343764140381~00 CARD2 CUSTCPS_KEY9 343764140381~01 CARD2 This card must be presented each time services are.

3 10-03-2019 Call UMR at the member customer service number listed on this ID Card for plan required prior authorization. FAILURE TO CALL FOR PRIOR AUTHORIZATION MAY REDUCE :877-950-5083 Providers: : EDI # 39026, UMR, po box 30541, Salt Lake City, UT 84130-0541 Vision Claims: Spectera Vision, po box 30978, Salt Lake City, UT 84130 This card must be presented each time services are : 10-03-2019 Call UMR at the member customer service number listed on this ID Card for plan required prior authorization. FAILURE TO CALL FOR PRIOR AUTHORIZATION MAY REDUCE :877-950-5083 Providers: : EDI # 39026, UMR, po box 30541, Salt Lake City, UT 84130-0541 Vision Claims: Spectera Vision, po box 30978, Salt Lake City, UT 84130 Shipper ID: 00000000 Insert #1 Insert #2 Shipping Method: DIRECTI nsert #3 Insert #4 CARRIER: USPSI nsert #5 Insert #6 Address:Insert #7 Insert #8 JONATHON G SAMPLEI nsert #9 Insert #10 115 W WAUSAU AVEI nsert #11 Insert #12 WAUSAU, WI 54401 Cycle Date: 20191004 PDF Date: Sat Oct 05, 2019 @ 17:48:27 MaxMover: NMailing/Meter Date: UHG JOB ID: 8100 GRP: 76414038 PV: 001 RC: E+S MKT: MT: 00 SA: 90 OI: 02 FORM: K2H000 CPAY: PKG ID: DALE BROWN: N LETTER NM: LETTER2 DIVISION : CARD TYPE: TEMPLATE: TPA B10 : FAMILY T50 : 2 SHRTSORT HCN.

4 Issuer (80840) 911-39026-02 Member ID: Group Number:Member:Dependents:SUSAN M SAMPLE 01 MED DEN VISC opays:Office $20 / Spec $405010 Administered by UMR Teladoc $1034376414038176-414038 JONATHON G SAMPLE 00 MED DEN VISI ssuer (80840) 911-39026-02 Member ID: Group Number:Member:Dependents:SUSAN M SAMPLE 01 MED DEN VISC opays:Office $20 / Spec $405010 Administered by UMR Teladoc $1034376414038176-414038 JONATHON G SAMPLE 00 MED DEN VIS03122 9590397 0000 0000290 0000282 277 6 116 03122 9590397 0000 0000290 0000282 277 6 116 RUN_DATE 20191005 17:48:27 DATA_SEQ_NO 0000001 CLIENT_NUMBER 003122 UHG_TYPE DIG2 SHRTDOC_ID DOC_SEQ_ID 0000290 NAME SAMPLE.

5 JONATHONMAILSET_NUMBER 0000282 CUSTCPS_KEY1 343764140381343764140381_KEY0 CARD1 CUSTCPS_KEY1 343764140381343764140381_KEY0 CARD2 CUSTCPS_KEY2 76414038 CUSTCPS_KEY2 76414038 CUSTCPS_KEY3 JONATHONCUSTCPS_KEY3 JONATHONCUSTCPS_KEY4 HCAC/MedicalCUSTCPS_KEY4 HCAC/MedicalCUSTCPS_KEY5 00 CUSTCPS_KEY5 01 CUSTCPS_KEY5 00 CUSTCPS_KEY5 01 CUSTCPS_KEY6 20200101 CUSTCPS_KEY6 20200101 CUSTCPS_KEY7 343764140381~00 CARD1 CUSTCPS_KEY7 343764140381~01 CARD1 CUSTCPS_KEY7 343764140381~00 CARD2 CUSTCPS_KEY7 343764140381~01 CARD2 CUSTCPS_KEY8 343764140381 CUSTCPS_KEY8 343764140381 CUSTCPS_KEY9 343764140381~00 CARD1 CUSTCPS_KEY9 343764140381~01 CARD1 CUSTCPS_KEY9 343764140381~00 CARD2 CUSTCPS_KEY9 343764140381~01 CARD2 This card must be presented each time services are : 10-03-2019 Call UMR at the member customer service number listed on this ID Card for plan required prior authorization.

6 FAILURE TO CALL FOR PRIOR AUTHORIZATION MAY REDUCE :877-950-5083 Providers: : EDI # 39026, UMR, po box 30541, Salt Lake City, UT 84130-0541 Vision Claims: Spectera Vision, po box 30978, Salt Lake City, UT 84130 This card must be presented each time services are : 10-03-2019 Call UMR at the member customer service number listed on this ID Card for plan required prior authorization. FAILURE TO CALL FOR PRIOR AUTHORIZATION MAY REDUCE :877-950-5083 Providers: : EDI # 39026, UMR, po box 30541, Salt Lake City, UT 84130-0541 Vision Claims: Spectera Vision, po box 30978, Salt Lake City, UT 84130 Shipper ID: 00000000 Insert #1 Insert #2 Shipping Method: DIRECTI nsert #3 Insert #4 CARRIER: USPSI nsert #5 Insert #6 Address:Insert #7 Insert #8 JONATHON G SAMPLEI nsert #9 Insert #10 115 W WAUSAU AVEI nsert #11 Insert #12 WAUSAU, WI 54401 Cycle Date: 20191004 PDF Date: Sat Oct 05, 2019 @ 17:48:27 MaxMover: NMailing/Meter Date: UHG JOB ID: 8100 GRP: 76414038 PV: 001 RC: E+S MKT: MT: 00 SA: 90 OI: 02 FORM: K2H000 CPAY: PKG ID: DALE BROWN: N LETTER NM: LETTER2 DIVISION : CARD TYPE: TEMPLATE: TPA B10 : FAMILY T50 : 2 SHRTSORT HCN.

7 The number assigned specifically to you to track all of your benefits and claims information. The number assigned to identify your group health medical provider network, also referred to as your preferred provider organization (PPO). Going to doctors, clinics and hospitals in your network will save you list of the family members who are covered under your plan. Call this number for any questions about your medical benefits or when you need medical services and your plan requires prior authorization for those you ever wondered what all that stuff on your ID card really means? Here s a sample of what you might see. Each plan is on the backLook for important contact information, including the customer service phone number to call for answers to claims or benefit questions. You can also go to to check your benefits, claims status, accumulators and eligibility.