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Your Insurance Provider (Alabama)* Please select Aetna All Savers Health Plans Alliant Health Plans Allied Benefit Solutions AmBetter Anthem BlueCross BlueShield BlueCross and BlueShield of Alabama BlueCross BlueShield Cigna Highmark BlueCross BlueShield Humana Medicaid Meritain Health Surest Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Viva Health Other
Your Insurance Provider (Alaska)* Please select Aetna BlueCross BlueShield Cigna Employee Benefit Management Services - EBMS GEHA Aetna Signature Administrators Highmark BlueCross BlueShield Humana Medicaid Meritain Health Moda Health Premera BlueCross Tricare UMR United Healthcare (UHC) Other
Your Insurance Provider (Arizona)* Please select Aetna All Savers Health Plans AmBetter AmeriBen Anthem BlueCross BlueShield Arizona Complete Health - Medicaid Banner University Health Plans Blue Cross Blue Shield of Arizona BlueCross BlueShield Bright Health Care First Arizona a Wellcare Company Cigna Excellus BlueCross BlueShield Highmark BlueCross BlueShield Humana Mayo Clinic Health Solutions Medicaid Mercy Care Plan - Medicaid Meritain Health Oscar Regence BlueCross BlueShield Steward Health Choice - Medicaid Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Other
Your Insurance Provider (Arkansas)* Please select Aetna AmBetter Anthem BlueCross BlueShield Arkansas Blue Cross and Blue Shield Arkansas Total Care BlueCross BlueShield Cigna Health scope Humana Medicaid Qualchoice Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources Other
Your Insurance Provider (California)* Please select Aetna Alameda Alliance For Health AmBetter Anthem BlueCross BlueShield Blue Shield of California BlueCross BlueShield Cal Viva Health California Health and Wellness CalOptima Central California Alliance Cigna Community Health Group Medi-cal Contra Costa Health Plan Gold Coast Health Plan Health Net California Health Plan of San Mateo Humana Inland Empire Health Plan - IEHP Kaiser Foundation Health Plan Kern Family Health Plan Medicaid Meritain Health Molina Oscar Partnership Health Plan Santa Clara Health Sharp Health Plan The Health Plan of San Joaquin Tricare UMR United Healthcare (UHC) United Healthcare Community Plan United Healthcare Student Resources Other
Your Insurance Provider (Colorado)* Please select Aetna All Savers Health Plans AmeriBen Anthem BlueCross BlueShield BlueCross BlueShield Bright Health Cigna First Health Humana Kaiser Foundation Health Plan Medicaid Medicaid - Health First Meritain Health Oscar Rocky Mountain Health Plans Tricare UMR United Healthcare (UHC) Other
Your Insurance Provider (Connecticut)* Please select Aetna Anthem BlueCross BlueShield BlueCross BlueShield Cigna Connecticare Harvard Pilgrim Health Care Humana Medicaid Tricare UMR United Healthcare (UHC) United Healthcare Oxford United Healthcare Student Resources Other
Your Insurance Provider (Delaware)* Please select Aetna AmeriHealth Caritas Anthem BlueCross BlueShield BlueCross BlueShield Cigna Delaware First Health Highmark BlueCross BlueShield Humana Independence BlueCross BlueShield Medicaid Meritain Health Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources Other
Your Insurance Provider (District of Columbia)* Please select Aetna AmeriHealth Caritas Anthem BlueCross BlueShield BlueCross BlueShield CareFirst BlueCross BlueShield Cigna Humana Kaiser Foundation Health Plan Medicaid Oxford Health Plans Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Other
Your Insurance Provider (Florida)* Please select Aetna Aetna Better Health All Savers Health Plans AmBetter Anthem BlueCross BlueShield AvMed BlueCross BlueShield Bright Health Cigna Excellus BlueCross BlueShield Florida Blue Health scope Humana Inland Empire Health Plan - IEHP Magellan Complete Care Mayo Clinic Health Solutions Medicaid Meritain Health Oscar Prestige Health Choice Simply Healthcare Sunshine Health Plan Tricare Trustmark UMR United Healthcare (UHC) United Healthcare (UHC) Community Plan United Healthcare Student Resources Wellcare Other
Your Insurance Provider (Georgia)* Please select Aetna All Savers Health Plans Alliant Health Plans AmBetter Amerigroup Anthem BlueCross BlueShield BlueCross BlueShield Caresource Cigna Healthgram Humana Kaiser Foundation Health Plan Medicaid Meritain Health Oscar Peach State Health Plan Peachcare Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources Wellcare Other
Your Insurance Provider (Hawaii)* Please select Aetna Anthem BlueCross BlueShield BlueCross BlueShield Cigna Humana Medicaid Ohana Health Plan Tricare United Healthcare (UHC) Other
Your Insurance Provider (Idaho)* Please select Aetna Anthem BlueCross BlueShield Blue Cross of Idaho BlueCross BlueShield Cigna Humana Medicaid Meritain Health PacificSource Health Plans Regence BlueCross BlueShield SelectHealth Tricare UMR United Healthcare (UHC) Other
Your Insurance Provider (Illinois)* Please select Aetna Aetna Better Health All Savers Health Plans AmBetter Anthem BlueCross BlueShield Blue Cross Blue Shield of Illinois BlueCross BlueShield Cigna CountyCare Health Plan Health Alliance Medical Plans Healthlink Humana Illinicare Health Medicaid Meridian Health Plan Meritain Health Next Level Health Tricare UMR United Healthcare (UHC) United Healthcare Student Resources United Healthcare Oxford Wellcare Other
Your Insurance Provider (Nevada)* Please select Aetna Ambetter Amerigroup Anthem BlueCross BlueShield Blue Shield of California BlueCross BlueShield Cigna Health scope Highmark BlueCross BlueShield Humana Medicaid Meritain Health Sierra Health and Life Silversummit Healthplan Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Other
Your Insurance Provider (New York)* Please select Aetna Aetna Better Health Affinity Health Plan Anthem BlueCross BlueShield BlueCross BlueShield BlueCross BlueShield of Western New York BlueShield of Northeastern New York CDPHP Cigna EmblemHealth Empire BlueCross BlueShield Excellus BlueCross BlueShield Fidelis Care Healthfirst Highmark BlueCross BlueShield Humana Independent Health Association Medicaid Meritain Health Metroplus Health Plan Molina MVP Health Plan Oscar Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Univera Healthcare Wellcare Other
Your Insurance Provider (North Carolina)* Please select Aetna All Savers Health Plans AmBetter AmeriHealth Caritas Blue Cross and Blue Shield of North Carolina BlueCross BlueShield Bright Health Carolina Complete Cigna Humana MedCost Medicaid Meritain Health Optima Oscar Tricare Trustmark UMR United Healthcare (UHC) United Healthcare (UHC) Community Plan United Healthcare Student Resources Vaya Health Wellcare Other
Your Insurance Provider (Ohio)* Please select Aetna All Savers Health Plans AmBetter Anthem BlueCross BlueShield AultCare BlueCross BlueShield Buckeye Community Health Plan Care First BlueCross BlueShield Caresources Cigna Highmark BlueCross BlueShield Humana Medben Medicaid Medical Mutual Meritain Health Ohio Healthy Optima Oscar Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources Other
Your Insurance Provider (Pennsylvania)* Please select Aetna Aetna Better Health All Savers Health Plans AmBetter AmeriHealth Caritas Anthem BlueCross BlueShield BlueCross BlueShield Capital BlueCross Cigna Excellus BlueCross BlueShield Gateway Health Plan Geisinger Health Plan Highmark BlueCross BlueShield Humana Independence BlueCross Medicaid Meritain Health Oscar PA Health and Wellness Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources UPMC Other
Your Insurance Provider (Tennessee)* Please select Aetna AmBetter Amerigroup Anthem BlueCross BlueShield BlueCareTennCare BlueCross BlueShield BlueCross BlueShield of Tennessee Bright Health Cigna Health scope Highmark BlueCross BlueShield Humana Medicaid Meritain Health Oscar Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Other
Your Insurance Provider (Texas)* Please select Aetna Aetna Better Health AmBetter Amerigroup Anthem BlueCross BlueShield BlueCross BlueShield Blue Cross and Blue Shield of Texas Boon-Chapman CHRISTUS Health Plan Cigna Cook Children Health Plan Driscoll Health Plan El Paso First Health Plan FirstCare Health Plans Highmark BlueCross BlueShield Humana Medicaid Meritain Health Oscar Parkland Community Health Plan Right Care - Scott & White Health Superior Health Plan - TX Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources WebTPA Other
Please enter your insurance provider’s name*
Your Policy Number*
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Partner's First Name **
Partner's Surname **
Partner's Email Address **
Partner's Date of Birth* Partner's Street Address **
Partner's City **
Select Partner's State ** Select Partner's State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Nevada New York North Carolina Ohio Pennsylvania Tennessee Texas
Partner's ZIP Code **
Partner's Insurance Provider (Alabama)* Please select Aetna All Savers Health Plans Alliant Health Plans Allied Benefit Solutions AmBetter Anthem BlueCross BlueShield BlueCross and BlueShield of Alabama BlueCross BlueShield Cigna Highmark BlueCross BlueShield Humana Medicaid Meritain Health Surest Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Viva Health Other
Partner's Insurance Provider (Alaska)* Please select Aetna BlueCross BlueShield Cigna Employee Benefit Management Services - EBMS GEHA Aetna Signature Administrators Highmark BlueCross BlueShield Humana Medicaid Meritain Health Moda Health Premera BlueCross Tricare UMR United Healthcare (UHC) Other
Partner's Insurance Provider (Arizona)* Please select Aetna All Savers Health Plans AmBetter AmeriBen Anthem BlueCross BlueShield Arizona Complete Health - Medicaid Banner University Health Plans Blue Cross Blue Shield of Arizona BlueCross BlueShield Bright Health Care First Arizona a Wellcare Company Cigna Excellus BlueCross BlueShield Highmark BlueCross BlueShield Humana Mayo Clinic Health Solutions Medicaid Mercy Care Plan - Medicaid Meritain Health Oscar Regence BlueCross BlueShield Steward Health Choice - Medicaid Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Other
Partner's Insurance Provider (Arkansas)* Please select Aetna AmBetter Anthem BlueCross BlueShield Arkansas Blue Cross and Blue Shield Arkansas Total Care BlueCross BlueShield Cigna Health scope Humana Medicaid Qualchoice Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources Other
Partner's Insurance Provider (California)* Please select Aetna Alameda Alliance For Health AmBetter Anthem BlueCross BlueShield Blue Shield of California BlueCross BlueShield Cal Viva Health California Health and Wellness CalOptima Central California Alliance Cigna Community Health Group Medi-cal Contra Costa Health Plan Gold Coast Health Plan Health Net California Health Plan of San Mateo Humana Inland Empire Health Plan - IEHP Kaiser Foundation Health Plan Kern Family Health Plan Medicaid Meritain Health Molina Oscar Partnership Health Plan Santa Clara Health Sharp Health Plan The Health Plan of San Joaquin Tricare UMR United Healthcare (UHC) United Healthcare Community Plan United Healthcare Student Resources Other
Partner's Insurance Provider (Colorado)* Please select Aetna All Savers Health Plans AmeriBen Anthem BlueCross BlueShield BlueCross BlueShield Bright Health Cigna First Health Humana Kaiser Foundation Health Plan Medicaid Medicaid - Health First Meritain Health Oscar Rocky Mountain Health Plans Tricare UMR United Healthcare (UHC) Other
Partner's Insurance Provider (Connecticut)* Please select Aetna Anthem BlueCross BlueShield BlueCross BlueShield Cigna Connecticare Harvard Pilgrim Health Care Humana Medicaid Tricare UMR United Healthcare (UHC) United Healthcare Oxford United Healthcare Student Resources Other
Partner's Insurance Provider (Delaware)* Please select Aetna AmeriHealth Caritas Anthem BlueCross BlueShield BlueCross BlueShield Cigna Delaware First Health Highmark BlueCross BlueShield Humana Independence BlueCross BlueShield Medicaid Meritain Health Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources Other
Partner's Insurance Provider (District of Columbia)* Please select Aetna AmeriHealth Caritas Anthem BlueCross BlueShield BlueCross BlueShield CareFirst BlueCross BlueShield Cigna Humana Kaiser Foundation Health Plan Medicaid Oxford Health Plans Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Other
Partner's Insurance Provider (Florida)* Please select Aetna Aetna Better Health All Savers Health Plans AmBetter Anthem BlueCross BlueShield AvMed BlueCross BlueShield Bright Health Cigna Excellus BlueCross BlueShield Florida Blue Health scope Humana Inland Empire Health Plan - IEHP Magellan Complete Care Mayo Clinic Health Solutions Medicaid Meritain Health Oscar Prestige Health Choice Simply Healthcare Sunshine Health Plan Tricare Trustmark UMR United Healthcare (UHC) United Healthcare (UHC) Community Plan United Healthcare Student Resources Wellcare Other
Partner's Insurance Provider (Georgia)* Please select Aetna All Savers Health Plans Alliant Health Plans AmBetter Amerigroup Anthem BlueCross BlueShield BlueCross BlueShield Caresource Cigna Healthgram Humana Kaiser Foundation Health Plan Medicaid Meritain Health Oscar Peach State Health Plan Peachcare Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources Wellcare Other
Partner's Insurance Provider (Hawaii)* Please select Aetna Anthem BlueCross BlueShield BlueCross BlueShield Cigna Humana Medicaid Ohana Health Plan Tricare United Healthcare (UHC) Other
Partner's Insurance Provider (Idaho)* Please select Aetna Anthem BlueCross BlueShield Blue Cross of Idaho BlueCross BlueShield Cigna Humana Medicaid Meritain Health PacificSource Health Plans Regence BlueCross BlueShield SelectHealth Tricare UMR United Healthcare (UHC) Other
Partner's Insurance Provider (Illinois)* Please select Aetna Aetna Better Health All Savers Health Plans AmBetter Anthem BlueCross BlueShield Blue Cross Blue Shield of Illinois BlueCross BlueShield Cigna CountyCare Health Plan Health Alliance Medical Plans Healthlink Humana Illinicare Health Medicaid Meridian Health Plan Meritain Health Next Level Health Tricare UMR United Healthcare (UHC) United Healthcare Student Resources United Healthcare Oxford Wellcare Other
Partner's Insurance Provider (Nevada)* Please select Aetna Ambetter Amerigroup Anthem BlueCross BlueShield Blue Shield of California BlueCross BlueShield Cigna Health scope Highmark BlueCross BlueShield Humana Medicaid Meritain Health Sierra Health and Life Silversummit Healthplan Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Other
Partner's Insurance Provider (New York)* Please select Aetna Aetna Better Health Affinity Health Plan Anthem BlueCross BlueShield BlueCross BlueShield BlueCross BlueShield of Western New York BlueShield of Northeastern New York CDPHP Cigna EmblemHealth Empire BlueCross BlueShield Excellus BlueCross BlueShield Fidelis Care Healthfirst Highmark BlueCross BlueShield Humana Independent Health Association Medicaid Meritain Health Metroplus Health Plan Molina MVP Health Plan Oscar Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Univera Healthcare Wellcare Other
Partner's Insurance Provider (North Carolina)* Please select Aetna All Savers Health Plans AmBetter AmeriHealth Caritas Blue Cross and Blue Shield of North Carolina BlueCross BlueShield Bright Health Carolina Complete Cigna Humana MedCost Medicaid Meritain Health Optima Oscar Tricare Trustmark UMR United Healthcare (UHC) United Healthcare (UHC) Community Plan United Healthcare Student Resources Vaya Health Wellcare Other
Partner's Insurance Provider (Ohio)* Please select Aetna All Savers Health Plans AmBetter Anthem BlueCross BlueShield AultCare BlueCross BlueShield Buckeye Community Health Plan Care First BlueCross BlueShield Caresources Cigna Highmark BlueCross BlueShield Humana Medben Medicaid Medical Mutual Meritain Health Ohio Healthy Optima Oscar Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources Other
Your Partner's Insurance Provider (Pennsylvania)* Please select Aetna Aetna Better Health All Savers Health Plans AmBetter AmeriHealth Caritas Anthem BlueCross BlueShield BlueCross BlueShield Capital BlueCross Cigna Excellus BlueCross BlueShield Gateway Health Plan Geisinger Health Plan Highmark BlueCross BlueShield Humana Independence BlueCross Medicaid Meritain Health Oscar PA Health and Wellness Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources UPMC Other
Partner's Insurance Provider (Tennessee)* Please select Aetna AmBetter Amerigroup Anthem BlueCross BlueShield BlueCareTennCare BlueCross BlueShield BlueCross BlueShield of Tennessee Bright Health Cigna Health scope Highmark BlueCross BlueShield Humana Medicaid Meritain Health Oscar Tricare UMR United Healthcare (UHC) United Healthcare Student Resources Other
Partner's Insurance Provider (Texas)* Please select Aetna Aetna Better Health AmBetter Amerigroup Anthem BlueCross BlueShield BlueCross BlueShield Blue Cross and Blue Shield of Texas Boon-Chapman CHRISTUS Health Plan Cigna Cook Children Health Plan Driscoll Health Plan El Paso First Health Plan FirstCare Health Plans Highmark BlueCross BlueShield Humana Medicaid Meritain Health Oscar Parkland Community Health Plan Right Care - Scott & White Health Superior Health Plan - TX Tricare Trustmark UMR United Healthcare (UHC) United Healthcare Student Resources WebTPA Other
Partner's Policy Number*
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