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Contact Employer Services
 
Please use this web form to:
* Request a new ID card to replace a lost or stolen card.
* Change a member's address or name if it recently changed.
* Ask a specific question about your coverage.
Note: To enroll a new member online, use our Employer's Member Enrollment Form. Messages are retrieved every business day between the hours of 8:00 a.m. and 5:00 p.m. Eastern Time.
 
Note: For security reasons, you may not request a replacement ID card and simultaneously change a member's address. Replacement cards will be sent to the address supplied by you originally. All change of address requests will be verified with you. This policy protects members from unauthorized use of health care plan benefits.
 
Member Identification: (all fields are required)
Employer:
 
Last Name:   First Name:   MI:
Email Address:
 
Date of Birth: Month:   Day:   Year:    SSN (no hyphens):
 
Replacement ID Cards:
  Provide a replacement ID Card for the subscriber above.
 
  For a family member.  Name:
 
Change of Name or Address:
New Last Name: First Name:   MI:
 
New Address: Street:
City:   State:   Zip:
 
Questions About Coverage:

Send Response To:
Name of person making inquiry:
(choose one)
Email Address:
Phone:
Mailing Address:

 
   
 
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