IERN TRUST COMPANY S100 RED HOOK QUARTER, B-3 STTHOMAS Vi 00802-0000 6: reader and scan this code to Won ened somanters Smertghone access to bene nd provider information with myulvc. com® mobée, receiving this card because your Trarecy benata services wil be administered by OptumRx - THIS CARD IS VALID AS OF 09/01/2013. >001600 3485303 001 003082 J.EPSTEIN 6100 RED HOOK QUARTER B-3 Fx Rx Bin: 610279 N Rx PCN: 9999 Rx Grp: UHC UnitedHealthcare Choice Plus Underwriter Dy Untediasiincrs ieuranca Company i 8 ile i 3 Payer 1D 87726 ER: $200 Spec: $30 Office: $20 UrgCare: $75 DOI. e501 Please Review: New Member ID Card Enclosed Your pharmacy benefit services will soon be administered by OptumRx. The attached ID card is updated with information needed to proces: your pharmacy claims PLEASE CONTINUE USING YOUR CURRENT CARD UNTIL THE EFFECTIVE DATE ON THE FRONT OF THIS have questions, please review the pharmacy transition letter and FAQ recently mailed to you from UnitedHealthcare or call the member phone number on the back of this card. Revise la Nueva Tarjeta de identificacién de Membresia Adjunta Prommamente, OptumRx administraré los servicios de sus identificacién @sta actualizada con be indormacion necesaria para procener $48 recamos farmacéuticos. SIGA USANDO SU TARJETA ACTUAL HASTA LA FECHA DE VIGENCIA QUE FIGURA EN EL ANVERSO DE ESTE TARJETERO. Sitene Preguntas. gonsulte ta carta sobre Ip transicion ce farmacieg y tas Preguntas Frecuenites que Unitediieaithcare le envio por correo recie moments, © a] numero de leiélono para menbros que se encuentra en ef tarjeta De Sn Aen! ot naa core sense. tate ibaa racy, Sons mak yuarsaten coverage Fees act, Ae wertcaten oi spy tr benatin ant comme 6008 Ail varbr'ee cvemage fy ome 2° Sewage Wi be Onterrwrwed weer the ares Sndcandiane yas peicy whan a came ST THOMAS VI 00802-0000 327 pes d cel ecole mm 7 press 28326 H ase zeae < CARD CARRIER. If ie. B23 s 4 fefgs| if: Be Spo sxe] 3g8 = pls 3s) 23 pee] & ae ee e 825 3 i. 2 i = FA f i z©0)6C EFTA00313239