Dear UnitedHealthcare Member: Enclosed is a temporary Group Benefits Identification Card. This ID card should be used for your benefit plan effective date of October 1, 2012. Present card to your provider or pharmacist on your next visit. When you receive a permanent ID card, please destroy this temporary card and replace with the permanent card. Thank you for your cooperation. Sincerely, UnitedHealthcare Implementation Manager
NAME
GROUP NUMBER
COMPANY
MEMBER NUMBER
CUSTOMER SERVICE
CLAIM ADDRESS
Mattress Firm
704140
800-996-0271
P.O. Box 30555 Salt Lake City, UT 84130-0555
Copays: OV/Spec/UC/ER $30/$60/$60/$250
RX Copay: Tier 1/Tier 2/ Tier 3 $10/$30/$50 UnitedHealthcare Choice Plus- Temporary ID Card This card does not prove membership nor guarantee coverage
This identification card is not proof of membership, nor does it guarantee coverage. Persons with coverage that remains in force are entitled to benefits under the terms and conditions of the group health benefit plan.