Sample ID Card

Below is a sample ID card. Note:

• Plan name and type is in the upper right-hand corner on the front of the card
• Medicare Part D coverage is indicated with the MedicareRx logo on the front of the card
• Helpful phone numbers are listed on the back of the card, along with the claims mailing address.

Remember to log on to ePRG or call Customer Service at 1-866-550-4736 (TTY: 711), October 15, 2011 – March 1, 2012: 8 a.m. – 8 p.m., 7 days a week; and March 2, 2012 – October 14, 2012: 8 a.m. – 8 p.m., Monday – Friday, to verify benefits and eligibility.

SAMPLE ID CARD