What to Ask When You Receive Your Health Insurance Card
Click on the buttons for questions
Insurance Company
Plan type:
Titanium PPO Plan
Effective Date:
01/01/2020
Prescription Group # XXXX
Prescription Co-Pay
$15.00
Generic
$20.00
Name Brand
Member Name:
John Doe
Member Number:
XXX-XX-XXX
Group Number:
XXXXX-XX
PCP:
Robin Jones, MD
PCP Co-Pay:
$15.00
Specialist Co-Pay:
$25.00
Emergency Room Co-Pay:
$75.00
Member Services:
800-XXX-XXX
www.myplan.com
Member Services:
800-XXX-XXX
Nurse Advice Line 24/7:
866-XXX-XXXX
Telehealth Services:
888-XXX-XXXX
Send claims to:
My Plan, INC
P.O. Box XXXX
City, State XXXXX