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Subscriber Number: 719999901 Effective Date: 01/01/2006
Group Number: 01A3456 Termination Date:
Product: Select Plus POS1   Definity CDHP Funding Status: Not Available
Insurance Type: Commercial HRA Balance: $1,000.00
Electronic Payer ID: 87726 Eligible for Language Assistance: Yes
Claims Address: P.O. Box 740800
Atlanta, GA 30374-0800 		Verbal Language Preference: ENGLISH
    Written Language Preference: VIETNAMESE
Eligibility Details
Patient Details
Name:   BOB PATIENT
Date of Birth:   06/24/1954
Gender:   M
Relationship:   Employee
Address   2029 NORMANDIE DR, MONTGOMERY, AL, 36111
Primary Care Physician Details
Provider Name:  
Provider Number:   0
Phone Number:  
Address:  
Start Date:  
End Date:  
Coordination of Benefits
Carrier Name:  
United Healthcare Primary: Yes
Date COB verified: 02/11/2009
   
Lab Information
Lab Name Start Date End Date
 
Radiology Information
Radiology Name Start Date End Date
*The Year-to-Date information provided reflects all claims processed. Please note, however, there may be claims that are pending that are not reflected in these totals.
**Eligibility verification is subject to the terms of your participation Agreement. This is not a guarantee of payment, payment is based on the terms of your Participation Agreement and the terms of the enrollee's benefit plan.
1 This member has a product that is jointly offered by UnitedHealthcare and Harvard Pilgrim Health Care. Please pay particular attention to where you need to send notifications and claims for this member.
2 Member is not enrolled in an HRA but may participate in another type of consumer driven account.
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