Fillable National General STM - Sample Documents (Insubuy)

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National General STM - Sample Documents (Insubuy)

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Accident & Health
Short Term Medical
Temporary Plan ID card
Member
Effective date
Policy Number
Preauthorize all required services as defined in the insurance certificate 48 hours prior
to treatment. Provide notice of all emergency admissions within 48 hours. Failure
to comply may result in penalties and/or reduction in benefits. Aetna-participating
doctors, dentists and hospitals are independent providers and are neither agents nor
employees of Aetna. This card does not guarantee or certify benefits.
Plans are underwritten by
National Health Insurance
Company, Integon National
Insurance Company, and
Integon Indemnity Corporation.
Office Visit Copay: Primary $40 / Specialty $60
SAMPLE ONLY
INSUBUY.COM
Jonathon Sharp
675430001-1410002
Mariella Sharp
03/14/2019
Benjamin Sharp
Claims correspondence
Electronic claims ID: 41124
Send claims by mail to:
Meritain Health
PO Box 853921
Richardson, TX 75085
Locate a PPO provider: 866-596-5817
MyNatGen.com/aetnaOpenChoicePPO
Preauthorization, claims,
& coverage information:
All other inquiries or
premium inquiries:
888-781-0585
866-596-5817
Send Rx claims by mail to:
Caremark
PO Box 52136
Phoenix, AZ 85072-2136
Pharmacy correspondence
Rx BIN: 004336
Rx PCN: ADV
Rx GRP: RX2740
Member services:
866-475-7589
Pharmacists services: 800-364-6331
SAMPLE ONLY
INSUBUY.COM
Get Started Today!
It’s easy to start saving today…
1. To locate a pharmacy, visit www . WellCardSavings . com
2. Keep the card in your wallet and present it at your local
pharmacy to save.
Hearing save up to 70%
Diabetic Care Services save up to 75%
Vitamins save up to 15%
Daily Living Products save up to 10%
Gain access to discount programs that can save you money in
more than one way:
This is Not Insurance. It is a discount medical program. It does not replace COBRA or any other medical insurance program nor is it a Medicare Part D prescripon drug plan.
Cardholders are responsible for paying the discounted cost at the me of service from parcipang providers. WellCard Savings is FREE. WellCard Savings will not share or sell
your personal informaon. The discount plan organizaon is AccessOne Consumer Health, Inc., 84 Villa Road, Greenville, SC, 29615, www . accessonedmpo . com. This program is not
available to residents of Montana, but may be used at participating Montana providers. Other state residents: visit www . WellCardSavings . com for full disclosure.
The WellCard Savings discount card is an easy way to help
you and your family with all your prescripon drug needs.
An Empowering
Health & Wellness Program
An Empowering
Health & Wellness Program
PRESENT THIS CARD TO YOUR PHARMACY
Locate a provider: call 877.827.8680 or visit
www . wellcardsavings . com. This is NOT
insurance.
AOWCID14
• CVS Pharmacy
• COSTCO Wholesale
• Walmart
• Target
• Walgreens
Accepted at these pharmacies plus many more national and
local pharmacies in your area.
PHARMACY
Patient: Simply present this card to a participating pharmacy to receive a
discount on your prescription. This card may not be used in conjunction with any
third party payer program, including but not limited to Medicaid or Medicare.
Pharmacist: Card must be presented to receive program benefits. For processing
questions, call Argus Health Systems at 866.921.7286.
This plan is NOT Insurance. It is a discount medical program.
Payment must be made at time of service.
This program is powered by AccessOne Consumer Health, Inc.
www . accessonedmpo . com This is a free program. Void where prohibited by law.
Rx BIN: 600428
Rx PCN: 07440002
Rx Group: LIFEASSN
Cardholder ID: 800001234
Jonathon Sharp
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National General STM - Sample Documents (Insubuy)

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Completed 10 May 2021

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