Patient Pre-Registration
Register
Demographics
***Please ensure that the patient name and date of birth are identical to the information appearing on the patient's government issued ID***
Patient Last Name
Patient First Name
Middle Initial
Patient Date of Birth
Patient Street Address
Patient Address Line 2
Patient City
Patient State / Province
Select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Patient Zip Code
Patient Email address
Patient mobile number
Sex (at birth)
Select...
Male
Female
Other
Unknown
Race
Select...
American Indian or Alaska Native
Asian
Black or African American
Multi-racial
Native Hawaiian or other Pacific Islander
White
Other
Unknown
Prefers not to share
Ethnicity
Select...
Hispanic or Spanish origin
Not Hispanic or Spanish origin
Prefers not to share
Please upload an image of your id or enter your drivers license number.
Id Card (Parent/Guardian ID for patients under 18)
Please take a photo of your id card and upload.
Drivers license number
Parent/Guardian Minor Consent
Parent/Guardian Name
Relationship To Patient
Primary Insurance
Insurance Provider
Other/Custom
AARP
"ACS Benefit Services, Inc"
Administrative Services Inc
Advantage by Bridgeway Health Solutions
Advantage by Buckeye Community Health Plan
Advantage by Managed Health Services
Advantage by Superior HealthPlan
Aetna
Aetna Administrator Medicare Supplement
Aetna Better Health (CA)
Aetna Better Health (FL)
Aetna Better Health (IL)
Aetna Better Health (KS)
Aetna Better Health (KY)
Aetna Better Health (LA)
Aetna Better Health (MD)
Aetna Better Health (MI)
Aetna Better Health (NE)
Aetna Better Health (NJ)
Aetna Better Health (NV)
Aetna Better Health (OH)
Aetna Better Health (PA)
Aetna Better Health (TX)
Aetna Better Health (TX) CHIP
Aetna Better Health (VA)
Aetna Better Health (WV)
Aetna Long Term Care
Aetna Senior Supplemental
Aetna Signature Administrator
Affinity Essentials
Affinity Health Plan
Affinity Health Plan Medicare
Aflac
AFLAC - Dental
AFLAC - Medicare Supplemental
AGIA Inc
Alabama Medicaid
Alan Sturm and Associates - Dental
Alaska Medicaid
Allegiance Benefit Plan Management
Alliant Health Plan of Georgia
Allied Benefit Systems
All Savers Life Insurance
AlohaCare
"Alternative Insurance Resources, Inc"
Altus Dental
Ambetter New Hampshire Healthy Families
Ambetter of Arkansas
Ambetter Superior Health Plan (TX)
Ameriben
American General Life and Accident
American Health Medicare
American Income Life Ins.Co.
American Insurance Administrators
American Medical Security (AMS)
American NationalInsurance
American National Life Ins Texas
American Network Ins. Medicare Supplement
American Postal Workers Union (APWU)
American Republic Insurance Company (ARIC)
American Retirement Life Ins Co. Medicare Supp
AmeriChoice of New Jersey (Commercial)
AmeriChoice of New Jersey (Medicaid)
Americo Financial Life and Annuity
Amerigroup
AmeriHealth
AmeriHealth Caritas DC
AmeriHealth Caritas Delaware
AmeriHealth Caritas Iowa
AmeriHealth Caritas Louisiana (LaCare)
AmeriHealth Caritas Pennsylvania
AmeriHealth Caritas VIP Care Plus
"AmeriHealth (DE, NJ, PA)"
AmeriHealth New Jersey
Amerihealth Northeast
AmeriHealth Pennsylvania
AmeriHealth VIP Care
Ameritas Group - Ameritas Life Insurance Co.
Ameritas Group - First Ameritas of New York
Ameritas Group - First Reliance Standard Life
Ameritas Group - Reliance Standard Life
Ameritas Group - Standard Insurance
Ameritas Group - Standard Insurance of New York
Antares
Anthem Vivity
Apex Benefits Services
Arise Health Care
Arise Health Plan Medicare Select Policy
Arizona Medicaid (AHCCCS)
Arizona Physicians IPA (APIPA)
Arkansas Medicaid
Arkansas TotalCare
Associacion De Maestros Puerto Rico
Asuris Northwest Health
Atrio Health Plans OR
AultCare
Automated Benefit Services
Auxiant
Avera Health Plans
AvMed Health Plans
Bankers Fidelity Life Insurance
Bankers Life & Casualty
Banner University Family Care
Baycare Select Health Plans
BCBS Delaware
BCBSMN Blue Plus Medicaid
BCBS of Alabama
BCBS of Alabama [Institutional]
BCBS of Arizona
BCBS of Arkansas
BCBS of Central New York
BCBS of Colorado (Wellpoint)
BCBS of Connecticut (Wellpoint)
BCBS of Florida
BCBS of Georgia (Wellpoint)
BCBS of Hawaii
BCBS of ILCommunity
BCBS of Illinois
BCBS of Indiana
BCBS of Iowa
BCBS of Kansas
BCBS of Kansas City
BCBS of Kentucky (Wellpoint)
BCBS of Louisiana
BCBS of Maine (Wellpoint)
BCBS of Massachusetts
BCBS of Michigan (Institutional)
BCBS of Michigan (Professional)
BCBS of Minnesota
BCBS of Mississippi
BCBS of Missouri(Wellpoint)
BCBS of Montana
BCBS of Nebraska
BCBS of Nevada (Wellpoint)
BCBS of New Hampshire (Wellpoint)
BCBS of New Jersey (Horizon)
BCBS of New Mexico
BCBS of New York (Empire)
BCBS of New York Excellus
BCBS of North Carolina
BCBS of North Dakota
BCBS of Ohio Wellpoint
BCBS of Oklahoma
BCBS of Oregon (Regence)
BCBS of Pennsylvania (Highmark) [Institutional]
BCBS of Pennsylvania (Highmark) [Professional]
BCBS of Rhode Island
BCBS of South Carolina
BCBS of South Dakota (Wellmark)
BCBS of Tennessee
BCBS of Texas
BCBS of the Rochester Area (NY)
BCBS of Utica-Watertown (NY)
BCBS of Vermont
BCBS of Virginia (Wellpoint)
BCBS of Western New York
BCBS of West Virginia Yes
BCBS of Wisconsin (Wellpoint)
BCBS of Wyoming
BCBS Texas Medicaid STAR CHIP
Behavioral Health Systems
Benefit Management Inc
Best Life and Health
Better Health Plans of Florida
Better Health Plans (Unison Health Plans)
Blue Benefit Administrators of Mass
BlueChoice HealthPlan South Carolina Medicaid
Blue Cross Community Options IL
Blue Cross Independence (Pennsylvania)
"Blue Cross Medicare Advantage (MT, OK, TX, IL, NM)"
Blue Cross Northeastern Pennsylvania
Blue Cross of California (Wellpoint)
Blue Cross of Idaho
Blue Cross of Utah (Regence)
Blue Cross of Washington and Alaska (Premera)
Blue Cross Pennsylvania (Capital)
Blue Shield New York - Northeastern (BCBS NY)
Blue Shield of California
Blue Shield of Idaho (Regence)
Blue Shield of North Eastern New York
Blue Shield of Washington (Regence)
BMC HealthNet Plan
Boon Group
"Bravo Health, Inc."
Bridgespan
Bridgestone Americas Inc
Bright Health
Bright Health Medicare Advantage
Brokers National- Dental
"Butler Benefit Services, Inc."
California Medicaid (Medi-Cal)
CalOptima
Cal-Viva
Capital District Physicians Health Plan (CDPHP)
Capital Health Plan
Capitol Administrators
CAPROCK
Care1st Health Plan Arizona
CareFirst Administrators
Carefirst Blue Cross Blue Shield DC
Carefirst Blue Cross Blue Shield MD
Care Improvement Plus
CareMore
Care Oregon
CarePlus Health Plan
Caresource Georgia
CareSource Health
CareSource Indiana
Caresource West Virginia
"Carolina Care Plan, Inc. (CCP)"
CDS Group Health
Celtic Insurance
CenCal
Cenpatico - Arizona
Cenpatico Behavioral Health
Cenpatico Behavioral Health Texas
Cenpatico - Florida
Cenpatico - Georgia
Cenpatico - Illinois
Cenpatico - Indiana
Cenpatico - Kansas
Cenpatico - Kentucky
Cenpatico - Massachusetts
Cenpatico - Mississippi
Cenpatico - Missouri
Cenpatico - New Hampshire
Cenpatico - Ohio
Cenpatico - South Carolina
Cenpatico - Texas
Cenpatico - Wisconsin
Centene - Absolute TotalCare
Centene - Advantage by Peach State
Centene - Advantage by Sunshine State
Centene - Advantage Plans
Centene - Ambetter Sunshine Health
Centene - Bridgeway Arizona
Centene - Buckeye Community Health
Centene - California Health & Wellness
Centene - Celticare
Centene - Coordinated Care
Centene - Granite State Health Plan
Centene - Home State Health Plan
Centene - IlliniCare Health Plan
Centene - Kentucky Spirit Health Plan
Centene - Louisiana Healthcare Connections
Centene - Magnolia Health Plan
Centene - Managed Health Services Indiana
Centene - Managed Health Services Wisconsin
Centene - Michigan Fidelis Secure Care
Centene - New Hampshire Healthy Families
Centene - Peach State Health Plan
Centene - Sunshine State Health Plan
Centene - Superior Health Plan TX
Centene - TotalCare Carolina
CentralCalifornia Alliance for Health
CentralReserve Insurance Company
CentralReserve Life Ins Co. Medicare Supp
Central Senior Care
Central States Fund
Central States Health & Life Co of Omaha
Central States Indemnity
Cerner Health Plan
CHAMPVA/Spina Bifida/Children of Women Vietnam Vets
CHC - Advantra Freedom
CHC - Advantra Savings
"CHC - Advantra (TX, NM, AZ Only)"
CHC - Altius Health Plans
CHC - Coventry Cares of Kentucky
CHC - Coventry Health and Life - Nevada
CHC - Coventry Health and Life (Oklahoma)
CHC - Coventry Health and Life (Tenn)
CHC - Coventry Health Care Federal
CHC - Coventry Missouri
CHC - CoventryOne
CHC - Delaware
CHC Florida
CHC - Georgia
CHC - Group Health Plan (GHP)
CHC - HealthCare Inc. (Promina)
CHC Illinois
CHC - Iowa
CHC - Kansas
CHC - Louisiana
CHC - Mail Handlers Benefit Plan
CHC - Nebraska
CHC of Carolinas
CHC - University of Missouri
CHC West Virginia
Childrens Mercy PCN
CHP Direct
Christian Brothers Services
Christie Student Health Plans
CHRISTUS HEALTH MEDICARE ADVANTAGE
CHRISTUS HEALTH NEW MEXICO
CHRISTUS HEALTH PLAN TEXAS HIX
CIGNA-GreatWest
Clear Health Alliance
Clover Health
CMFG Life Insurance
Colonial Penn Life
Colorado Access
Colorado Medicaid
Commerce Benefits Group
Common Ground WI
Community Care of Oklahoma
Community Health Choice
Community HealthFirst Medicare Advantage
Community Health Group CHG
Community Health Plan of Washington (CHPW)
Concentrix Insurance Solutions
ConnectiCare
Connecticare - Medicare
Connecticut Medicaid
Consolidated Associates Railroad
Consolidated Health Plan
Consumers Life
Consumers Mutual of Michigan
Continental General Ins Co. Medicare Supp (Cigna Supplemental)
Cook Children's Health Plan
Cooperative Benefit Administrators (CBA)
CoOportunity Yes
CoreSouce (FMH)
CoreSource (Little Rock)
"CoreSource (MD,PA,IL,NC,IN,AZ,MN)"
CoreSource (OH)
Country Life Insurance Company
Covenant Administrators (TPA)
Coventry Carelink Medicaid
CoventryCares of Maryland
CoventryCares of Michigan
CoventryCares of Nebraska
CoventryCares of Pennsylvania
Coventry Healthcare - Diamond Plan
Coventry Healthcare National Network
Coventry Health Care USA (HCUSA)
Cox Health Plan
CrystalRun Health Plans
CSA Fraternal Life Medicare Supp
CSI Life Insurance Company
Culinary Health Fund
Culinary Health Fund UNITE HERE Health
DakotaCare
Dean Health Plan
DeCare Dental Health Insurance
Definity Health
Delaware Medicaid
Delaware Physicians Care
Dell Childrens Health Plan
DeltaCare USA - Claims
DeltaCare USA - Encounters
Delta DentalIns. Co. - Alabama
Delta DentalIns. Co. - Florida
Delta DentalIns. Co. - Georgia
Delta DentalIns. Co. - Louisiana
Delta DentalIns. Co. - Mississippi
Delta DentalIns. Co. - Montana
Delta DentalIns. Co. - Nevada
Delta DentalIns. Co. - Texas
Delta DentalIns. Co. - Utah
Delta Dental of California
Delta Dental of Colorado
Delta Dental of Connecticut
Delta Dental of Delaware
Delta Dental of Hawaii
Delta Dental of Indiana
Delta Dental of Maryland
Delta Dental of Michigan
Delta Dental of Minnesota
Delta Dental of Nebraska
Delta Dental of New Jersey
Delta Dental of New Mexico
Delta Dental of New York
Delta Dental of North Carolina
Delta Dental of North Dakota
Delta Dental of Ohio
Delta Dental of Pennsylvania
Delta Dental of Rhode Island
Delta Dental of Tennessee
Delta Dental of Virginia
Delta Dental of Washington DC
Delta Dental of Washington State
Delta Dental of West Virginia
DentalBenefit Providers
Denver Health Medical Plan
Deseret Mutual(DMBA)
Devoted Health FL
Director's Guild
District 9 IA of MAW Welfare Trust
District of Columbia Medicaid
Driscoll Health Plan
EBMS
Educators MutualInsurance (EMI)
Elderplan
Emblem Health
Employee Benefit Services - Dental
Empower Arkansas
Equitable Life Casualty Insurance Company
Essence Healthcare
Evercare
Everence Financial
Everest Reinsurance Company
Evergreen Health Co-Op
Expert Benefit Solutions
Fallon Community Health Plan
Farm Bureau Health Plans
FCE Benefit Administrators
Federated Insurance Company
Fidelis Care New York
FirstCare
First Carolina Care
First Community Health Plan
First Health Network (Coventry National)
First Medical Network
First United American Ins.Co
Flex Compensation - Dental
Florida Combined Life - DENTAL
FLORIDA HEALTH CARE PLANS
Florida Medicaid
Florida True Health
Food Employers & Bakery
Freedom Blue
Fresenius Health
Fresenius MedicalCare
Fringe Benefits
Gateway Health Plan
Geisinger Health Plan
Geisinger Health Plan Gold
Generations Healthcare
Georgia Medicaid
GHI
Gilsbar
Globe Life & Accident Ins.Co.
Golden Rule Insurance
Government Employees Hospital Association (GEHA)
Great American Life Insurance Co. Medicare Supp
Great Southern Life Insurance Company
Greek Catholic Union of the USA
Group Hospitalization and Medical Services
Group Practice Affiliates
Guardian Life Insurance Co. of America - Dental
Harken Health
Harmony Health Plan
Hawaii Medicaid
Hawaii Medical Assurance Association
Health Alliance Medical Plan (IL)
Health Alliance Medical Plans (HAP)
Health America of PA
Healthcare Highways
Health Choice Arizona
Health Choice Oklahoma
HealthComp Administrators
Health Cost Solutions
HealthEase
HealthEase Kids
HEALTHe Exchange
Health First Health Plan
Health First Insurance
Healthfirst New York
Healthfirst of New Jersey
Healthgram (Primary PhysiciansCare)
Healthkeepers (Anthem)
HealthMarkets (Chesapeake National Life)
HealthMarkets (Mega Life and Health Insurance)
HealthMarkets (Mid-West National Life)
HealthMarkets (TransAmerica Life)
Health Net National
Health New England
HealthNow
Health Partners of MN
Health Partners of Philadelphia
Health Partners Pennsylvania
HealthPlan of Nevada
Health Plan of San Mateo
Health Plan of Upper Ohio Valley
Healthplan Services - Celtic Insurance Company
HealthPlans Inc
HealthPlus of Michigan
HealthScope
HEALTH SERVICES CHILDREN SPECIAL NEEDS
Health Share of Oregon
HealthSmart Benefit Solutions
HealthSmart Benefit Solutions (Wells Fargo TPA)
Healthsource Provident - Dental
HealthSpring
Healthteam Advantage
Heartland National Life Insurance Company
Heritage Physician Network (Houston)
Hershey Healthsmile - Dental
Highmark Senior Solutions Company
HIPNY
HMA Hawaii Mainland Admin
Hometown Health
Horizon NJ Health
HSBS Memphis
HSBS Oklahoma City
Humana
Humana CareSource (KY)
Humana Dental
IBM Insurance Outsourcing Services
iCare (Independent Care Health Plan)
iCare Independent Care Health Plan
Idaho Medicaid
IHC Health Solutions
Illinois Medicaid
Independence Administrators Yes
Independent Health
Indiana Medicaid
Indiana University Health Plan Medicare
Indiana University Health Plans Commercial
Inland Empire Health
Insurers Administrative Corporation (IAC)
Integrated Mental Health Services
Inter Valley Health Plan
Iowa Medicaid
Iowa Total Care
Island Home Insurance
Jackson Memorial Hospital Health Plan
John Hopkins Health Plan
Johns Hopkins HealthCare LLC
Johns Hopkins US Family Health Plan MD
Kaiser Foundation Health Plan of Colorado
Kaiser Foundation Health Plan of Hawaii
Kaiser Foundation Health Plan of Hawaii(DHMO Choice)
Kaiser Foundation Health Plan of the Mid-Atlantic
Kaiser Foundation Health Plan of the Northwest
Kaiser Foundation Health Plan of Washington
Kaiser Permanente of Georgia
Kaiser Permanente of Northern CA
Kaiser Permanente of Southern CA
Kansas Medicaid
Katy Medical Group
Kentucky Medicaid
Kentucky Passport
Key Benefits Administrators (IN)
Keystone First Community Health Plan
Keystone Mercy Health
Keystone VIP Care
Kitsap Physician Services
KSKJ Life
LA CARE HEALTH PLAN
Leggett & Platt
Leon MedicalCenters Health Plan
Leon MedicalCenters Health Plans
Liberty National Life Ins.Co.
Lifetime Benefit Solutions (RMSCO)
Lifewise Arizona
Lifewise Health Plan of Oregon
Lifewise Health Plan of Washington
Lincoln Financial
Lincoln Heritage
Local 1199
LoneStar TPA
Loomis Company
Louisiana Health Exchange
Louisiana Medicaid
Loyal American Life Insurance Co. Medicare Supp
Lumico Life Insurance
Magellan Behavioral Health
Magellan Complete Care of Virginia
Magnacare
Maine Medicaid
MAMSI Health Plan
Managed Care of America
Managed Care Systems CA
Managed Health Network (MHN)
MAPFRE Life Puerto Rico
Maricopa Care Advantage (Arizona)
Maricopa Health Plan (Arizona)
Martin's Point
Maryland Medicaid
Massachusetts Medicaid
MedBen
MedCost Benefit Services
Medica2 Individual Family
Medica Health Plans
Medicaid
Medica Insurance
Medical Associates Health Plan/Health Choices
MedicalCard System
Medical Mutual of Ohio
Medicare
Medicare y Mucho Mas (INMEDIATA HEALTH GRP CORP)
Medigold Health Plans
Med-Pay Inc
MedStar Family Choice
MedStar Health Plan
Mega Health
Mega Life (Oklahoma City)
Mercy Care Plan (Arizona)
Meridian Health Plan of Illinois
Meritain Health
Meritus Health Partners
MetLife Dental Family
MetroPlus Health Plan
Metropolitan Health Plan (MHP)
MHNET Behavioral Health
Michigan Medicaid
Michigan Medicaid Pending Eligibility
Michigan MIChild
Minnesota Medicaid
MississippiChildren's Health Insurance Program
Mississippi Medicaid
Mississippi State Employees and Teachers
MissouriCare
Missouri Health Plan (Community & State)
Missouri Medicaid
MMM of Florida
MMSI (Mayo Health)
Moda Health
Molina Healthcare of California
Molina Healthcare of Florida
Molina Healthcare of Idaho
Molina Healthcare of Illinois
Molina Healthcare of Michigan
Molina Healthcare of New Mexico
Molina Healthcare of Ohio
Molina Healthcare of Puerto Rico
Molina Healthcare of South Carolina
Molina Healthcare of Texas
Molina Healthcare of Utah
Molina Healthcare of Washington
Molina Healthcare of Wisconsin
Montana Medicaid
Municipal Health Benefit Fund
Mutual Health Services
Mutual of Omaha
Mutual of Omaha Medicare Advantage
MVP Health Care (New York)
"NaphCare,Inc."
National Association of Letter Carriers (NALC)
National Telecommunications Cooperative Association (NTCA)
Nebraska Medicaid
Nebraska TotalCare
NEHEN - Harvard Pilgrim Health Care
NEHEN - Neighborhood Health Plans
Neighborhood Health Partnership
Neighborhood Health Plan (RI)
Network Health Insurance Corp
Network Health Plan of WI
Nevada Medicaid
New Era Life Insurance Co.
New Hampshire Medicaid
New Jersey Medicaid
New Mexico Medicaid
New York Medicaid
North Carolina Medicaid
North Dakota Medicaid
Northwest Administrators
Nova Healthcare Administrators
NovaSys Health
Ohana Health Plan
Ohio Medicaid
Oklahoma Employees Group Insurance Division
Oklahoma Medicaid
Operating Engineers Local No.428
Optima/Sentara
Orange County Fire Authority
Oregon Medicaid
Oscar (NY)
Oxford Health Plans
Pacificare Washington
PacificSource Administrators
PacificSource Community Solustions Medicaid
Pacific Source Health Plan
PacificSource Medicare
Pan-American Life Insurance
Panamerican Life Puerto Rico (PALIC)
Paramount Health
Partnership Health Plan of California
Partners National Health Plans of NC
Patriot Dental
Pennsylvania Health and Wellness
Pennsylvania Medicaid
Penn Treaty Network America Ins Medicare Supp
Peoples Health
Perkin Life Insurance
PersonalInsurance Administrators (PIA)
Phoenix Health Plan
Physicians Health Plan Northern IN
Physicians Health Plan of Mid-Michigan
Physicians MutualInsurance Company
Physicians Plus Insurance Corp
Piedmont
Pinnacle Claims Management
Pinnacle Physician Management Org
Plan de Salud Hospital Menonita
Planned Administrator Inc
POMCO
Preferred Care Partners
Preferred Medicare Choice(PMC)(INMEDIATA HEALTH GRP)
PreferredOne
Premier Health
PRESBYTERIAN HEALTH PLAN
Prestige Health Choice
PrimeWest Health
Principal Financial Group (Nippon Life)
Principal Life (Principal Life Financial Group)
Priority Health
ProfessionalBenefits Administrators
Prominence Health Plan of Nevada
Prominence Health Plan of Texas
Providence Health Plan
Provident American Life & Health Ins. Co. Mcare Supp
Provident Preferred Network - Dental
Public Employees Health Program
Puerto Rico Medicaid
Puritan Life Insurance
Qualcare
Qualchoice
QuikTrip Corporation
Recall Systems - Boon-Chapman Benefit Admin
Recall Systems - Corporate Benefit Service
Recall Systems - Group & Pension Administrators
Recall Systems - Underwriters Safety & Claims
Reserve NationalInsurance Company
Rhode Island Medicaid
RiverLink Health
Rocky Mountain Health Plan
Royal Neighbors of America
S and S Healthcare Strategies
Sanford Health Plan
San Francisco Health Plan
San Joaquin Health Plan
Santa Clara Family Health Plan
Schaller Anderson Aetna Better Health of New York
Schaller Anderson Aetna Better Health OH
"Schaller Anderson Delaware Physicians, Inc"
Schaller Anderson MajestaCare Virginia
Schaller Anderson Maryland Physicians Care
Schaller Anderson Mercy Care
Schaller Anderson Mercy Maricopa
Schaller Anderson MissouriCare
Schaller Anderson Parkland Community Health Plan
Schaller Anderson Texas CHRISTUS
Scott and White Health Plan
Secure Health Plans of Wisconsin
Securian Dental
Securian/Patriot Dental
Security Health Plan
SelectCare of Texas (Beaumont)
SelectCare of Texas (Golden Triangle)
SelectCare of Texas (Houston)
SelectCare of Texas (Integranet)
SelectCare of Texas (Kelsey-Seybold)
SelectCare of Texas (MemorialClinical Assoc)
SelectCare of Texas (Northwest Diagnostic)
Select Health SC
Select Health Utah
Select Senior Clinic
Selman & Company
Sendero IdealCare
Senior Care Action Network (SCAN) HMO
Senior Health Services Center-Univ American Family Co.
Senior Whole Health
Sharp Health Plan
Shenandoah Life Insurance
Sierra Health Services
Significa Benefit Services
SilverSummit Health Plan
Simply Healthcare Long Term Care
Simply Healthcare Plans
SisCo Benefits
Soundpath Health
South Carolina Medicaid
South Country Health Alliance
South Country Health Alliance Medicaid
South Dakota Medicaid
Southeastern Indiana Health Organization
Southern Health Services
Special Agents MutualBenefit Assoc
Spectrum Health
SPJST Medicare Supplement
Standard Life and Accident Insurance
State Farm
State Mutual(Lincoln Novation)
State Mutual Med Supp
StayWell
Staywell Kids
Stewart C Miller and Co
Stonebridge Life Insurance Company
StudentResources
SummaCare Health Plan
Summit America Insurance Service
Summit Community Care
Sunflower State Health (Kansas)
Sutter Health Plus
Sutter Select
TennDent
Tennessee Medicaid
TexanPlus (Integranet)
TexanPlus (Kelsey-Seybold)
TexanPlus North Texas Area
TexanPlus Southeast Texas Area
Texas First Health Plan (TOPA)
Texas Medicaid
Texas Medicaid - Long Term Care
The Kempton Company
The ULLICO Family of Companies
Three Rivers Health Plans (Unison Health Plan)
Thrivent
Today's Health
Today's Option
TransactRX Infusion and Specialty
TransactRX Part D
TransAmerica Admin by KBA
Transamerica Premier Life Insurance Company
"Triad Healthcare, Inc"
Tribute-SelectCare of Oklahoma
Tricare East
TRICARE for Life
TRICARE Overseas
Tricare West
TRICARE West formerly North
Trillium Community Health Plan
Triple S Advantage Puerto Rico
Triple-S Salud BCBS Puerto Rico
Trustmark Insurance
Tufts Health Plan
UCare of Minnesota
Ultimate Health Plans
UMR
UNICARE - Dental
Unicare (Wellpoint)
Union Pacific Railroad Employees Health Systems
United American Ins.Company
"United Concordia Companies, Inc. - DENTAL"
United Concordia Federal Employees Program - DENTAL
United Healthcare
United Healthcare Community Plan - Kansas
United Healthcare Community Plan - Missouri
"United Healthcare Community Plan (OH,PA,SC)"
United Healthcare Community Plan - Tennessee
United Healthcare Facets Detroit Community and State
United Healthcare Facets Pittsburgh Community and State
United Healthcare Nevada Market
United Healthcare Plan of River Valley
United Healthcare SecureHorizons
United Healthcare Student Resources
United Mine Workers UMWA
United Teacher Assoc Insurance Co. Mcare Supp
Unity Health Plans
Univera
Universal American
UniversalBenefit Corp
University Care Advantage Arizona
University Family Care
University of Arizona Health Plans - UHM
University of Utah Health Plans
University Physicians Care Advantage (Arizona)
University Physicians Healthcare Group (Arizona)
UPMC Health Plan (Tristate)
USAA Life Insurance Company
Utah Medicaid
VA Fee Basis Program
VA Health Administration Center
VA Healthcare
Valley Care Program
Valley Health Plan
"Vantage Health Plan,Inc"
Vermont Medicaid
Village Family Practice
Virginia Medicaid
VIVA Health
VNS CHOICE
Vytra
Washington Medicaid
Washington National
WEA Trust
"WEB-TPA, Inc"
Wellcare Health Plans
Wellsense
Western Health Advantage
West Virginia Medicaid
Wilson McShane - Dental
Windsor Health Plan
Windsor Medicare Extra
Wisconsin Medicaid
Wisconsin Medicaid Chronic Disease Program
Wisconsin Medicaid Well Woman Program
World Corp
World Insurance (ARIC)
WPS Health Insurance
Wyoming Medicaid
YourCare Health Plan
Custom/Other Insurance Provider Name
Verification of custom insurance providers is not guaranteed
Member ID
Group Number (Optional)
Medical Insurance Card - FRONT
Please take a photo of the front of your insurance card and upload.
Medical Insurance Card - BACK
Please take a photo of the back of your insurance card and upload.
Secondary Insurance
Insurance Provider
Other/Custom
AARP
"ACS Benefit Services, Inc"
Administrative Services Inc
Advantage by Bridgeway Health Solutions
Advantage by Buckeye Community Health Plan
Advantage by Managed Health Services
Advantage by Superior HealthPlan
Aetna
Aetna Administrator Medicare Supplement
Aetna Better Health (CA)
Aetna Better Health (FL)
Aetna Better Health (IL)
Aetna Better Health (KS)
Aetna Better Health (KY)
Aetna Better Health (LA)
Aetna Better Health (MD)
Aetna Better Health (MI)
Aetna Better Health (NE)
Aetna Better Health (NJ)
Aetna Better Health (NV)
Aetna Better Health (OH)
Aetna Better Health (PA)
Aetna Better Health (TX)
Aetna Better Health (TX) CHIP
Aetna Better Health (VA)
Aetna Better Health (WV)
Aetna Long Term Care
Aetna Senior Supplemental
Aetna Signature Administrator
Affinity Essentials
Affinity Health Plan
Affinity Health Plan Medicare
Aflac
AFLAC - Dental
AFLAC - Medicare Supplemental
AGIA Inc
Alabama Medicaid
Alan Sturm and Associates - Dental
Alaska Medicaid
Allegiance Benefit Plan Management
Alliant Health Plan of Georgia
Allied Benefit Systems
All Savers Life Insurance
AlohaCare
"Alternative Insurance Resources, Inc"
Altus Dental
Ambetter New Hampshire Healthy Families
Ambetter of Arkansas
Ambetter Superior Health Plan (TX)
Ameriben
American General Life and Accident
American Health Medicare
American Income Life Ins.Co.
American Insurance Administrators
American Medical Security (AMS)
American NationalInsurance
American National Life Ins Texas
American Network Ins. Medicare Supplement
American Postal Workers Union (APWU)
American Republic Insurance Company (ARIC)
American Retirement Life Ins Co. Medicare Supp
AmeriChoice of New Jersey (Commercial)
AmeriChoice of New Jersey (Medicaid)
Americo Financial Life and Annuity
Amerigroup
AmeriHealth
AmeriHealth Caritas DC
AmeriHealth Caritas Delaware
AmeriHealth Caritas Iowa
AmeriHealth Caritas Louisiana (LaCare)
AmeriHealth Caritas Pennsylvania
AmeriHealth Caritas VIP Care Plus
"AmeriHealth (DE, NJ, PA)"
AmeriHealth New Jersey
Amerihealth Northeast
AmeriHealth Pennsylvania
AmeriHealth VIP Care
Ameritas Group - Ameritas Life Insurance Co.
Ameritas Group - First Ameritas of New York
Ameritas Group - First Reliance Standard Life
Ameritas Group - Reliance Standard Life
Ameritas Group - Standard Insurance
Ameritas Group - Standard Insurance of New York
Antares
Anthem Vivity
Apex Benefits Services
Arise Health Care
Arise Health Plan Medicare Select Policy
Arizona Medicaid (AHCCCS)
Arizona Physicians IPA (APIPA)
Arkansas Medicaid
Arkansas TotalCare
Associacion De Maestros Puerto Rico
Asuris Northwest Health
Atrio Health Plans OR
AultCare
Automated Benefit Services
Auxiant
Avera Health Plans
AvMed Health Plans
Bankers Fidelity Life Insurance
Bankers Life & Casualty
Banner University Family Care
Baycare Select Health Plans
BCBS Delaware
BCBSMN Blue Plus Medicaid
BCBS of Alabama
BCBS of Alabama [Institutional]
BCBS of Arizona
BCBS of Arkansas
BCBS of Central New York
BCBS of Colorado (Wellpoint)
BCBS of Connecticut (Wellpoint)
BCBS of Florida
BCBS of Georgia (Wellpoint)
BCBS of Hawaii
BCBS of ILCommunity
BCBS of Illinois
BCBS of Indiana
BCBS of Iowa
BCBS of Kansas
BCBS of Kansas City
BCBS of Kentucky (Wellpoint)
BCBS of Louisiana
BCBS of Maine (Wellpoint)
BCBS of Massachusetts
BCBS of Michigan (Institutional)
BCBS of Michigan (Professional)
BCBS of Minnesota
BCBS of Mississippi
BCBS of Missouri(Wellpoint)
BCBS of Montana
BCBS of Nebraska
BCBS of Nevada (Wellpoint)
BCBS of New Hampshire (Wellpoint)
BCBS of New Jersey (Horizon)
BCBS of New Mexico
BCBS of New York (Empire)
BCBS of New York Excellus
BCBS of North Carolina
BCBS of North Dakota
BCBS of Ohio Wellpoint
BCBS of Oklahoma
BCBS of Oregon (Regence)
BCBS of Pennsylvania (Highmark) [Institutional]
BCBS of Pennsylvania (Highmark) [Professional]
BCBS of Rhode Island
BCBS of South Carolina
BCBS of South Dakota (Wellmark)
BCBS of Tennessee
BCBS of Texas
BCBS of the Rochester Area (NY)
BCBS of Utica-Watertown (NY)
BCBS of Vermont
BCBS of Virginia (Wellpoint)
BCBS of Western New York
BCBS of West Virginia Yes
BCBS of Wisconsin (Wellpoint)
BCBS of Wyoming
BCBS Texas Medicaid STAR CHIP
Behavioral Health Systems
Benefit Management Inc
Best Life and Health
Better Health Plans of Florida
Better Health Plans (Unison Health Plans)
Blue Benefit Administrators of Mass
BlueChoice HealthPlan South Carolina Medicaid
Blue Cross Community Options IL
Blue Cross Independence (Pennsylvania)
"Blue Cross Medicare Advantage (MT, OK, TX, IL, NM)"
Blue Cross Northeastern Pennsylvania
Blue Cross of California (Wellpoint)
Blue Cross of Idaho
Blue Cross of Utah (Regence)
Blue Cross of Washington and Alaska (Premera)
Blue Cross Pennsylvania (Capital)
Blue Shield New York - Northeastern (BCBS NY)
Blue Shield of California
Blue Shield of Idaho (Regence)
Blue Shield of North Eastern New York
Blue Shield of Washington (Regence)
BMC HealthNet Plan
Boon Group
"Bravo Health, Inc."
Bridgespan
Bridgestone Americas Inc
Bright Health
Bright Health Medicare Advantage
Brokers National- Dental
"Butler Benefit Services, Inc."
California Medicaid (Medi-Cal)
CalOptima
Cal-Viva
Capital District Physicians Health Plan (CDPHP)
Capital Health Plan
Capitol Administrators
CAPROCK
Care1st Health Plan Arizona
CareFirst Administrators
Carefirst Blue Cross Blue Shield DC
Carefirst Blue Cross Blue Shield MD
Care Improvement Plus
CareMore
Care Oregon
CarePlus Health Plan
Caresource Georgia
CareSource Health
CareSource Indiana
Caresource West Virginia
"Carolina Care Plan, Inc. (CCP)"
CDS Group Health
Celtic Insurance
CenCal
Cenpatico - Arizona
Cenpatico Behavioral Health
Cenpatico Behavioral Health Texas
Cenpatico - Florida
Cenpatico - Georgia
Cenpatico - Illinois
Cenpatico - Indiana
Cenpatico - Kansas
Cenpatico - Kentucky
Cenpatico - Massachusetts
Cenpatico - Mississippi
Cenpatico - Missouri
Cenpatico - New Hampshire
Cenpatico - Ohio
Cenpatico - South Carolina
Cenpatico - Texas
Cenpatico - Wisconsin
Centene - Absolute TotalCare
Centene - Advantage by Peach State
Centene - Advantage by Sunshine State
Centene - Advantage Plans
Centene - Ambetter Sunshine Health
Centene - Bridgeway Arizona
Centene - Buckeye Community Health
Centene - California Health & Wellness
Centene - Celticare
Centene - Coordinated Care
Centene - Granite State Health Plan
Centene - Home State Health Plan
Centene - IlliniCare Health Plan
Centene - Kentucky Spirit Health Plan
Centene - Louisiana Healthcare Connections
Centene - Magnolia Health Plan
Centene - Managed Health Services Indiana
Centene - Managed Health Services Wisconsin
Centene - Michigan Fidelis Secure Care
Centene - New Hampshire Healthy Families
Centene - Peach State Health Plan
Centene - Sunshine State Health Plan
Centene - Superior Health Plan TX
Centene - TotalCare Carolina
CentralCalifornia Alliance for Health
CentralReserve Insurance Company
CentralReserve Life Ins Co. Medicare Supp
Central Senior Care
Central States Fund
Central States Health & Life Co of Omaha
Central States Indemnity
Cerner Health Plan
CHAMPVA/Spina Bifida/Children of Women Vietnam Vets
CHC - Advantra Freedom
CHC - Advantra Savings
"CHC - Advantra (TX, NM, AZ Only)"
CHC - Altius Health Plans
CHC - Coventry Cares of Kentucky
CHC - Coventry Health and Life - Nevada
CHC - Coventry Health and Life (Oklahoma)
CHC - Coventry Health and Life (Tenn)
CHC - Coventry Health Care Federal
CHC - Coventry Missouri
CHC - CoventryOne
CHC - Delaware
CHC Florida
CHC - Georgia
CHC - Group Health Plan (GHP)
CHC - HealthCare Inc. (Promina)
CHC Illinois
CHC - Iowa
CHC - Kansas
CHC - Louisiana
CHC - Mail Handlers Benefit Plan
CHC - Nebraska
CHC of Carolinas
CHC - University of Missouri
CHC West Virginia
Childrens Mercy PCN
CHP Direct
Christian Brothers Services
Christie Student Health Plans
CHRISTUS HEALTH MEDICARE ADVANTAGE
CHRISTUS HEALTH NEW MEXICO
CHRISTUS HEALTH PLAN TEXAS HIX
CIGNA-GreatWest
Clear Health Alliance
Clover Health
CMFG Life Insurance
Colonial Penn Life
Colorado Access
Colorado Medicaid
Commerce Benefits Group
Common Ground WI
Community Care of Oklahoma
Community Health Choice
Community HealthFirst Medicare Advantage
Community Health Group CHG
Community Health Plan of Washington (CHPW)
Concentrix Insurance Solutions
ConnectiCare
Connecticare - Medicare
Connecticut Medicaid
Consolidated Associates Railroad
Consolidated Health Plan
Consumers Life
Consumers Mutual of Michigan
Continental General Ins Co. Medicare Supp (Cigna Supplemental)
Cook Children's Health Plan
Cooperative Benefit Administrators (CBA)
CoOportunity Yes
CoreSouce (FMH)
CoreSource (Little Rock)
"CoreSource (MD,PA,IL,NC,IN,AZ,MN)"
CoreSource (OH)
Country Life Insurance Company
Covenant Administrators (TPA)
Coventry Carelink Medicaid
CoventryCares of Maryland
CoventryCares of Michigan
CoventryCares of Nebraska
CoventryCares of Pennsylvania
Coventry Healthcare - Diamond Plan
Coventry Healthcare National Network
Coventry Health Care USA (HCUSA)
Cox Health Plan
CrystalRun Health Plans
CSA Fraternal Life Medicare Supp
CSI Life Insurance Company
Culinary Health Fund
Culinary Health Fund UNITE HERE Health
DakotaCare
Dean Health Plan
DeCare Dental Health Insurance
Definity Health
Delaware Medicaid
Delaware Physicians Care
Dell Childrens Health Plan
DeltaCare USA - Claims
DeltaCare USA - Encounters
Delta DentalIns. Co. - Alabama
Delta DentalIns. Co. - Florida
Delta DentalIns. Co. - Georgia
Delta DentalIns. Co. - Louisiana
Delta DentalIns. Co. - Mississippi
Delta DentalIns. Co. - Montana
Delta DentalIns. Co. - Nevada
Delta DentalIns. Co. - Texas
Delta DentalIns. Co. - Utah
Delta Dental of California
Delta Dental of Colorado
Delta Dental of Connecticut
Delta Dental of Delaware
Delta Dental of Hawaii
Delta Dental of Indiana
Delta Dental of Maryland
Delta Dental of Michigan
Delta Dental of Minnesota
Delta Dental of Nebraska
Delta Dental of New Jersey
Delta Dental of New Mexico
Delta Dental of New York
Delta Dental of North Carolina
Delta Dental of North Dakota
Delta Dental of Ohio
Delta Dental of Pennsylvania
Delta Dental of Rhode Island
Delta Dental of Tennessee
Delta Dental of Virginia
Delta Dental of Washington DC
Delta Dental of Washington State
Delta Dental of West Virginia
DentalBenefit Providers
Denver Health Medical Plan
Deseret Mutual(DMBA)
Devoted Health FL
Director's Guild
District 9 IA of MAW Welfare Trust
District of Columbia Medicaid
Driscoll Health Plan
EBMS
Educators MutualInsurance (EMI)
Elderplan
Emblem Health
Employee Benefit Services - Dental
Empower Arkansas
Equitable Life Casualty Insurance Company
Essence Healthcare
Evercare
Everence Financial
Everest Reinsurance Company
Evergreen Health Co-Op
Expert Benefit Solutions
Fallon Community Health Plan
Farm Bureau Health Plans
FCE Benefit Administrators
Federated Insurance Company
Fidelis Care New York
FirstCare
First Carolina Care
First Community Health Plan
First Health Network (Coventry National)
First Medical Network
First United American Ins.Co
Flex Compensation - Dental
Florida Combined Life - DENTAL
FLORIDA HEALTH CARE PLANS
Florida Medicaid
Florida True Health
Food Employers & Bakery
Freedom Blue
Fresenius Health
Fresenius MedicalCare
Fringe Benefits
Gateway Health Plan
Geisinger Health Plan
Geisinger Health Plan Gold
Generations Healthcare
Georgia Medicaid
GHI
Gilsbar
Globe Life & Accident Ins.Co.
Golden Rule Insurance
Government Employees Hospital Association (GEHA)
Great American Life Insurance Co. Medicare Supp
Great Southern Life Insurance Company
Greek Catholic Union of the USA
Group Hospitalization and Medical Services
Group Practice Affiliates
Guardian Life Insurance Co. of America - Dental
Harken Health
Harmony Health Plan
Hawaii Medicaid
Hawaii Medical Assurance Association
Health Alliance Medical Plan (IL)
Health Alliance Medical Plans (HAP)
Health America of PA
Healthcare Highways
Health Choice Arizona
Health Choice Oklahoma
HealthComp Administrators
Health Cost Solutions
HealthEase
HealthEase Kids
HEALTHe Exchange
Health First Health Plan
Health First Insurance
Healthfirst New York
Healthfirst of New Jersey
Healthgram (Primary PhysiciansCare)
Healthkeepers (Anthem)
HealthMarkets (Chesapeake National Life)
HealthMarkets (Mega Life and Health Insurance)
HealthMarkets (Mid-West National Life)
HealthMarkets (TransAmerica Life)
Health Net National
Health New England
HealthNow
Health Partners of MN
Health Partners of Philadelphia
Health Partners Pennsylvania
HealthPlan of Nevada
Health Plan of San Mateo
Health Plan of Upper Ohio Valley
Healthplan Services - Celtic Insurance Company
HealthPlans Inc
HealthPlus of Michigan
HealthScope
HEALTH SERVICES CHILDREN SPECIAL NEEDS
Health Share of Oregon
HealthSmart Benefit Solutions
HealthSmart Benefit Solutions (Wells Fargo TPA)
Healthsource Provident - Dental
HealthSpring
Healthteam Advantage
Heartland National Life Insurance Company
Heritage Physician Network (Houston)
Hershey Healthsmile - Dental
Highmark Senior Solutions Company
HIPNY
HMA Hawaii Mainland Admin
Hometown Health
Horizon NJ Health
HSBS Memphis
HSBS Oklahoma City
Humana
Humana CareSource (KY)
Humana Dental
IBM Insurance Outsourcing Services
iCare (Independent Care Health Plan)
iCare Independent Care Health Plan
Idaho Medicaid
IHC Health Solutions
Illinois Medicaid
Independence Administrators Yes
Independent Health
Indiana Medicaid
Indiana University Health Plan Medicare
Indiana University Health Plans Commercial
Inland Empire Health
Insurers Administrative Corporation (IAC)
Integrated Mental Health Services
Inter Valley Health Plan
Iowa Medicaid
Iowa Total Care
Island Home Insurance
Jackson Memorial Hospital Health Plan
John Hopkins Health Plan
Johns Hopkins HealthCare LLC
Johns Hopkins US Family Health Plan MD
Kaiser Foundation Health Plan of Colorado
Kaiser Foundation Health Plan of Hawaii
Kaiser Foundation Health Plan of Hawaii(DHMO Choice)
Kaiser Foundation Health Plan of the Mid-Atlantic
Kaiser Foundation Health Plan of the Northwest
Kaiser Foundation Health Plan of Washington
Kaiser Permanente of Georgia
Kaiser Permanente of Northern CA
Kaiser Permanente of Southern CA
Kansas Medicaid
Katy Medical Group
Kentucky Medicaid
Kentucky Passport
Key Benefits Administrators (IN)
Keystone First Community Health Plan
Keystone Mercy Health
Keystone VIP Care
Kitsap Physician Services
KSKJ Life
LA CARE HEALTH PLAN
Leggett & Platt
Leon MedicalCenters Health Plan
Leon MedicalCenters Health Plans
Liberty National Life Ins.Co.
Lifetime Benefit Solutions (RMSCO)
Lifewise Arizona
Lifewise Health Plan of Oregon
Lifewise Health Plan of Washington
Lincoln Financial
Lincoln Heritage
Local 1199
LoneStar TPA
Loomis Company
Louisiana Health Exchange
Louisiana Medicaid
Loyal American Life Insurance Co. Medicare Supp
Lumico Life Insurance
Magellan Behavioral Health
Magellan Complete Care of Virginia
Magnacare
Maine Medicaid
MAMSI Health Plan
Managed Care of America
Managed Care Systems CA
Managed Health Network (MHN)
MAPFRE Life Puerto Rico
Maricopa Care Advantage (Arizona)
Maricopa Health Plan (Arizona)
Martin's Point
Maryland Medicaid
Massachusetts Medicaid
MedBen
MedCost Benefit Services
Medica2 Individual Family
Medica Health Plans
Medicaid
Medica Insurance
Medical Associates Health Plan/Health Choices
MedicalCard System
Medical Mutual of Ohio
Medicare
Medicare y Mucho Mas (INMEDIATA HEALTH GRP CORP)
Medigold Health Plans
Med-Pay Inc
MedStar Family Choice
MedStar Health Plan
Mega Health
Mega Life (Oklahoma City)
Mercy Care Plan (Arizona)
Meridian Health Plan of Illinois
Meritain Health
Meritus Health Partners
MetLife Dental Family
MetroPlus Health Plan
Metropolitan Health Plan (MHP)
MHNET Behavioral Health
Michigan Medicaid
Michigan Medicaid Pending Eligibility
Michigan MIChild
Minnesota Medicaid
MississippiChildren's Health Insurance Program
Mississippi Medicaid
Mississippi State Employees and Teachers
MissouriCare
Missouri Health Plan (Community & State)
Missouri Medicaid
MMM of Florida
MMSI (Mayo Health)
Moda Health
Molina Healthcare of California
Molina Healthcare of Florida
Molina Healthcare of Idaho
Molina Healthcare of Illinois
Molina Healthcare of Michigan
Molina Healthcare of New Mexico
Molina Healthcare of Ohio
Molina Healthcare of Puerto Rico
Molina Healthcare of South Carolina
Molina Healthcare of Texas
Molina Healthcare of Utah
Molina Healthcare of Washington
Molina Healthcare of Wisconsin
Montana Medicaid
Municipal Health Benefit Fund
Mutual Health Services
Mutual of Omaha
Mutual of Omaha Medicare Advantage
MVP Health Care (New York)
"NaphCare,Inc."
National Association of Letter Carriers (NALC)
National Telecommunications Cooperative Association (NTCA)
Nebraska Medicaid
Nebraska TotalCare
NEHEN - Harvard Pilgrim Health Care
NEHEN - Neighborhood Health Plans
Neighborhood Health Partnership
Neighborhood Health Plan (RI)
Network Health Insurance Corp
Network Health Plan of WI
Nevada Medicaid
New Era Life Insurance Co.
New Hampshire Medicaid
New Jersey Medicaid
New Mexico Medicaid
New York Medicaid
North Carolina Medicaid
North Dakota Medicaid
Northwest Administrators
Nova Healthcare Administrators
NovaSys Health
Ohana Health Plan
Ohio Medicaid
Oklahoma Employees Group Insurance Division
Oklahoma Medicaid
Operating Engineers Local No.428
Optima/Sentara
Orange County Fire Authority
Oregon Medicaid
Oscar (NY)
Oxford Health Plans
Pacificare Washington
PacificSource Administrators
PacificSource Community Solustions Medicaid
Pacific Source Health Plan
PacificSource Medicare
Pan-American Life Insurance
Panamerican Life Puerto Rico (PALIC)
Paramount Health
Partnership Health Plan of California
Partners National Health Plans of NC
Patriot Dental
Pennsylvania Health and Wellness
Pennsylvania Medicaid
Penn Treaty Network America Ins Medicare Supp
Peoples Health
Perkin Life Insurance
PersonalInsurance Administrators (PIA)
Phoenix Health Plan
Physicians Health Plan Northern IN
Physicians Health Plan of Mid-Michigan
Physicians MutualInsurance Company
Physicians Plus Insurance Corp
Piedmont
Pinnacle Claims Management
Pinnacle Physician Management Org
Plan de Salud Hospital Menonita
Planned Administrator Inc
POMCO
Preferred Care Partners
Preferred Medicare Choice(PMC)(INMEDIATA HEALTH GRP)
PreferredOne
Premier Health
PRESBYTERIAN HEALTH PLAN
Prestige Health Choice
PrimeWest Health
Principal Financial Group (Nippon Life)
Principal Life (Principal Life Financial Group)
Priority Health
ProfessionalBenefits Administrators
Prominence Health Plan of Nevada
Prominence Health Plan of Texas
Providence Health Plan
Provident American Life & Health Ins. Co. Mcare Supp
Provident Preferred Network - Dental
Public Employees Health Program
Puerto Rico Medicaid
Puritan Life Insurance
Qualcare
Qualchoice
QuikTrip Corporation
Recall Systems - Boon-Chapman Benefit Admin
Recall Systems - Corporate Benefit Service
Recall Systems - Group & Pension Administrators
Recall Systems - Underwriters Safety & Claims
Reserve NationalInsurance Company
Rhode Island Medicaid
RiverLink Health
Rocky Mountain Health Plan
Royal Neighbors of America
S and S Healthcare Strategies
Sanford Health Plan
San Francisco Health Plan
San Joaquin Health Plan
Santa Clara Family Health Plan
Schaller Anderson Aetna Better Health of New York
Schaller Anderson Aetna Better Health OH
"Schaller Anderson Delaware Physicians, Inc"
Schaller Anderson MajestaCare Virginia
Schaller Anderson Maryland Physicians Care
Schaller Anderson Mercy Care
Schaller Anderson Mercy Maricopa
Schaller Anderson MissouriCare
Schaller Anderson Parkland Community Health Plan
Schaller Anderson Texas CHRISTUS
Scott and White Health Plan
Secure Health Plans of Wisconsin
Securian Dental
Securian/Patriot Dental
Security Health Plan
SelectCare of Texas (Beaumont)
SelectCare of Texas (Golden Triangle)
SelectCare of Texas (Houston)
SelectCare of Texas (Integranet)
SelectCare of Texas (Kelsey-Seybold)
SelectCare of Texas (MemorialClinical Assoc)
SelectCare of Texas (Northwest Diagnostic)
Select Health SC
Select Health Utah
Select Senior Clinic
Selman & Company
Sendero IdealCare
Senior Care Action Network (SCAN) HMO
Senior Health Services Center-Univ American Family Co.
Senior Whole Health
Sharp Health Plan
Shenandoah Life Insurance
Sierra Health Services
Significa Benefit Services
SilverSummit Health Plan
Simply Healthcare Long Term Care
Simply Healthcare Plans
SisCo Benefits
Soundpath Health
South Carolina Medicaid
South Country Health Alliance
South Country Health Alliance Medicaid
South Dakota Medicaid
Southeastern Indiana Health Organization
Southern Health Services
Special Agents MutualBenefit Assoc
Spectrum Health
SPJST Medicare Supplement
Standard Life and Accident Insurance
State Farm
State Mutual(Lincoln Novation)
State Mutual Med Supp
StayWell
Staywell Kids
Stewart C Miller and Co
Stonebridge Life Insurance Company
StudentResources
SummaCare Health Plan
Summit America Insurance Service
Summit Community Care
Sunflower State Health (Kansas)
Sutter Health Plus
Sutter Select
TennDent
Tennessee Medicaid
TexanPlus (Integranet)
TexanPlus (Kelsey-Seybold)
TexanPlus North Texas Area
TexanPlus Southeast Texas Area
Texas First Health Plan (TOPA)
Texas Medicaid
Texas Medicaid - Long Term Care
The Kempton Company
The ULLICO Family of Companies
Three Rivers Health Plans (Unison Health Plan)
Thrivent
Today's Health
Today's Option
TransactRX Infusion and Specialty
TransactRX Part D
TransAmerica Admin by KBA
Transamerica Premier Life Insurance Company
"Triad Healthcare, Inc"
Tribute-SelectCare of Oklahoma
Tricare East
TRICARE for Life
TRICARE Overseas
Tricare West
TRICARE West formerly North
Trillium Community Health Plan
Triple S Advantage Puerto Rico
Triple-S Salud BCBS Puerto Rico
Trustmark Insurance
Tufts Health Plan
UCare of Minnesota
Ultimate Health Plans
UMR
UNICARE - Dental
Unicare (Wellpoint)
Union Pacific Railroad Employees Health Systems
United American Ins.Company
"United Concordia Companies, Inc. - DENTAL"
United Concordia Federal Employees Program - DENTAL
United Healthcare
United Healthcare Community Plan - Kansas
United Healthcare Community Plan - Missouri
"United Healthcare Community Plan (OH,PA,SC)"
United Healthcare Community Plan - Tennessee
United Healthcare Facets Detroit Community and State
United Healthcare Facets Pittsburgh Community and State
United Healthcare Nevada Market
United Healthcare Plan of River Valley
United Healthcare SecureHorizons
United Healthcare Student Resources
United Mine Workers UMWA
United Teacher Assoc Insurance Co. Mcare Supp
Unity Health Plans
Univera
Universal American
UniversalBenefit Corp
University Care Advantage Arizona
University Family Care
University of Arizona Health Plans - UHM
University of Utah Health Plans
University Physicians Care Advantage (Arizona)
University Physicians Healthcare Group (Arizona)
UPMC Health Plan (Tristate)
USAA Life Insurance Company
Utah Medicaid
VA Fee Basis Program
VA Health Administration Center
VA Healthcare
Valley Care Program
Valley Health Plan
"Vantage Health Plan,Inc"
Vermont Medicaid
Village Family Practice
Virginia Medicaid
VIVA Health
VNS CHOICE
Vytra
Washington Medicaid
Washington National
WEA Trust
"WEB-TPA, Inc"
Wellcare Health Plans
Wellsense
Western Health Advantage
West Virginia Medicaid
Wilson McShane - Dental
Windsor Health Plan
Windsor Medicare Extra
Wisconsin Medicaid
Wisconsin Medicaid Chronic Disease Program
Wisconsin Medicaid Well Woman Program
World Corp
World Insurance (ARIC)
WPS Health Insurance
Wyoming Medicaid
YourCare Health Plan
Custom/Other Insurance Provider Name
Verification of custom insurance providers is not guaranteed
Member ID
Group Number (Optional)
Medical Insurance Card - FRONT
Please take a photo of the front of your insurance card and upload.
Medical Insurance Card - BACK
Please take a photo of the back of your insurance card and upload.
Tertiary Insurance
Insurance Provider
Other/Custom
AARP
"ACS Benefit Services, Inc"
Administrative Services Inc
Advantage by Bridgeway Health Solutions
Advantage by Buckeye Community Health Plan
Advantage by Managed Health Services
Advantage by Superior HealthPlan
Aetna
Aetna Administrator Medicare Supplement
Aetna Better Health (CA)
Aetna Better Health (FL)
Aetna Better Health (IL)
Aetna Better Health (KS)
Aetna Better Health (KY)
Aetna Better Health (LA)
Aetna Better Health (MD)
Aetna Better Health (MI)
Aetna Better Health (NE)
Aetna Better Health (NJ)
Aetna Better Health (NV)
Aetna Better Health (OH)
Aetna Better Health (PA)
Aetna Better Health (TX)
Aetna Better Health (TX) CHIP
Aetna Better Health (VA)
Aetna Better Health (WV)
Aetna Long Term Care
Aetna Senior Supplemental
Aetna Signature Administrator
Affinity Essentials
Affinity Health Plan
Affinity Health Plan Medicare
Aflac
AFLAC - Dental
AFLAC - Medicare Supplemental
AGIA Inc
Alabama Medicaid
Alan Sturm and Associates - Dental
Alaska Medicaid
Allegiance Benefit Plan Management
Alliant Health Plan of Georgia
Allied Benefit Systems
All Savers Life Insurance
AlohaCare
"Alternative Insurance Resources, Inc"
Altus Dental
Ambetter New Hampshire Healthy Families
Ambetter of Arkansas
Ambetter Superior Health Plan (TX)
Ameriben
American General Life and Accident
American Health Medicare
American Income Life Ins.Co.
American Insurance Administrators
American Medical Security (AMS)
American NationalInsurance
American National Life Ins Texas
American Network Ins. Medicare Supplement
American Postal Workers Union (APWU)
American Republic Insurance Company (ARIC)
American Retirement Life Ins Co. Medicare Supp
AmeriChoice of New Jersey (Commercial)
AmeriChoice of New Jersey (Medicaid)
Americo Financial Life and Annuity
Amerigroup
AmeriHealth
AmeriHealth Caritas DC
AmeriHealth Caritas Delaware
AmeriHealth Caritas Iowa
AmeriHealth Caritas Louisiana (LaCare)
AmeriHealth Caritas Pennsylvania
AmeriHealth Caritas VIP Care Plus
"AmeriHealth (DE, NJ, PA)"
AmeriHealth New Jersey
Amerihealth Northeast
AmeriHealth Pennsylvania
AmeriHealth VIP Care
Ameritas Group - Ameritas Life Insurance Co.
Ameritas Group - First Ameritas of New York
Ameritas Group - First Reliance Standard Life
Ameritas Group - Reliance Standard Life
Ameritas Group - Standard Insurance
Ameritas Group - Standard Insurance of New York
Antares
Anthem Vivity
Apex Benefits Services
Arise Health Care
Arise Health Plan Medicare Select Policy
Arizona Medicaid (AHCCCS)
Arizona Physicians IPA (APIPA)
Arkansas Medicaid
Arkansas TotalCare
Associacion De Maestros Puerto Rico
Asuris Northwest Health
Atrio Health Plans OR
AultCare
Automated Benefit Services
Auxiant
Avera Health Plans
AvMed Health Plans
Bankers Fidelity Life Insurance
Bankers Life & Casualty
Banner University Family Care
Baycare Select Health Plans
BCBS Delaware
BCBSMN Blue Plus Medicaid
BCBS of Alabama
BCBS of Alabama [Institutional]
BCBS of Arizona
BCBS of Arkansas
BCBS of Central New York
BCBS of Colorado (Wellpoint)
BCBS of Connecticut (Wellpoint)
BCBS of Florida
BCBS of Georgia (Wellpoint)
BCBS of Hawaii
BCBS of ILCommunity
BCBS of Illinois
BCBS of Indiana
BCBS of Iowa
BCBS of Kansas
BCBS of Kansas City
BCBS of Kentucky (Wellpoint)
BCBS of Louisiana
BCBS of Maine (Wellpoint)
BCBS of Massachusetts
BCBS of Michigan (Institutional)
BCBS of Michigan (Professional)
BCBS of Minnesota
BCBS of Mississippi
BCBS of Missouri(Wellpoint)
BCBS of Montana
BCBS of Nebraska
BCBS of Nevada (Wellpoint)
BCBS of New Hampshire (Wellpoint)
BCBS of New Jersey (Horizon)
BCBS of New Mexico
BCBS of New York (Empire)
BCBS of New York Excellus
BCBS of North Carolina
BCBS of North Dakota
BCBS of Ohio Wellpoint
BCBS of Oklahoma
BCBS of Oregon (Regence)
BCBS of Pennsylvania (Highmark) [Institutional]
BCBS of Pennsylvania (Highmark) [Professional]
BCBS of Rhode Island
BCBS of South Carolina
BCBS of South Dakota (Wellmark)
BCBS of Tennessee
BCBS of Texas
BCBS of the Rochester Area (NY)
BCBS of Utica-Watertown (NY)
BCBS of Vermont
BCBS of Virginia (Wellpoint)
BCBS of Western New York
BCBS of West Virginia Yes
BCBS of Wisconsin (Wellpoint)
BCBS of Wyoming
BCBS Texas Medicaid STAR CHIP
Behavioral Health Systems
Benefit Management Inc
Best Life and Health
Better Health Plans of Florida
Better Health Plans (Unison Health Plans)
Blue Benefit Administrators of Mass
BlueChoice HealthPlan South Carolina Medicaid
Blue Cross Community Options IL
Blue Cross Independence (Pennsylvania)
"Blue Cross Medicare Advantage (MT, OK, TX, IL, NM)"
Blue Cross Northeastern Pennsylvania
Blue Cross of California (Wellpoint)
Blue Cross of Idaho
Blue Cross of Utah (Regence)
Blue Cross of Washington and Alaska (Premera)
Blue Cross Pennsylvania (Capital)
Blue Shield New York - Northeastern (BCBS NY)
Blue Shield of California
Blue Shield of Idaho (Regence)
Blue Shield of North Eastern New York
Blue Shield of Washington (Regence)
BMC HealthNet Plan
Boon Group
"Bravo Health, Inc."
Bridgespan
Bridgestone Americas Inc
Bright Health
Bright Health Medicare Advantage
Brokers National- Dental
"Butler Benefit Services, Inc."
California Medicaid (Medi-Cal)
CalOptima
Cal-Viva
Capital District Physicians Health Plan (CDPHP)
Capital Health Plan
Capitol Administrators
CAPROCK
Care1st Health Plan Arizona
CareFirst Administrators
Carefirst Blue Cross Blue Shield DC
Carefirst Blue Cross Blue Shield MD
Care Improvement Plus
CareMore
Care Oregon
CarePlus Health Plan
Caresource Georgia
CareSource Health
CareSource Indiana
Caresource West Virginia
"Carolina Care Plan, Inc. (CCP)"
CDS Group Health
Celtic Insurance
CenCal
Cenpatico - Arizona
Cenpatico Behavioral Health
Cenpatico Behavioral Health Texas
Cenpatico - Florida
Cenpatico - Georgia
Cenpatico - Illinois
Cenpatico - Indiana
Cenpatico - Kansas
Cenpatico - Kentucky
Cenpatico - Massachusetts
Cenpatico - Mississippi
Cenpatico - Missouri
Cenpatico - New Hampshire
Cenpatico - Ohio
Cenpatico - South Carolina
Cenpatico - Texas
Cenpatico - Wisconsin
Centene - Absolute TotalCare
Centene - Advantage by Peach State
Centene - Advantage by Sunshine State
Centene - Advantage Plans
Centene - Ambetter Sunshine Health
Centene - Bridgeway Arizona
Centene - Buckeye Community Health
Centene - California Health & Wellness
Centene - Celticare
Centene - Coordinated Care
Centene - Granite State Health Plan
Centene - Home State Health Plan
Centene - IlliniCare Health Plan
Centene - Kentucky Spirit Health Plan
Centene - Louisiana Healthcare Connections
Centene - Magnolia Health Plan
Centene - Managed Health Services Indiana
Centene - Managed Health Services Wisconsin
Centene - Michigan Fidelis Secure Care
Centene - New Hampshire Healthy Families
Centene - Peach State Health Plan
Centene - Sunshine State Health Plan
Centene - Superior Health Plan TX
Centene - TotalCare Carolina
CentralCalifornia Alliance for Health
CentralReserve Insurance Company
CentralReserve Life Ins Co. Medicare Supp
Central Senior Care
Central States Fund
Central States Health & Life Co of Omaha
Central States Indemnity
Cerner Health Plan
CHAMPVA/Spina Bifida/Children of Women Vietnam Vets
CHC - Advantra Freedom
CHC - Advantra Savings
"CHC - Advantra (TX, NM, AZ Only)"
CHC - Altius Health Plans
CHC - Coventry Cares of Kentucky
CHC - Coventry Health and Life - Nevada
CHC - Coventry Health and Life (Oklahoma)
CHC - Coventry Health and Life (Tenn)
CHC - Coventry Health Care Federal
CHC - Coventry Missouri
CHC - CoventryOne
CHC - Delaware
CHC Florida
CHC - Georgia
CHC - Group Health Plan (GHP)
CHC - HealthCare Inc. (Promina)
CHC Illinois
CHC - Iowa
CHC - Kansas
CHC - Louisiana
CHC - Mail Handlers Benefit Plan
CHC - Nebraska
CHC of Carolinas
CHC - University of Missouri
CHC West Virginia
Childrens Mercy PCN
CHP Direct
Christian Brothers Services
Christie Student Health Plans
CHRISTUS HEALTH MEDICARE ADVANTAGE
CHRISTUS HEALTH NEW MEXICO
CHRISTUS HEALTH PLAN TEXAS HIX
CIGNA-GreatWest
Clear Health Alliance
Clover Health
CMFG Life Insurance
Colonial Penn Life
Colorado Access
Colorado Medicaid
Commerce Benefits Group
Common Ground WI
Community Care of Oklahoma
Community Health Choice
Community HealthFirst Medicare Advantage
Community Health Group CHG
Community Health Plan of Washington (CHPW)
Concentrix Insurance Solutions
ConnectiCare
Connecticare - Medicare
Connecticut Medicaid
Consolidated Associates Railroad
Consolidated Health Plan
Consumers Life
Consumers Mutual of Michigan
Continental General Ins Co. Medicare Supp (Cigna Supplemental)
Cook Children's Health Plan
Cooperative Benefit Administrators (CBA)
CoOportunity Yes
CoreSouce (FMH)
CoreSource (Little Rock)
"CoreSource (MD,PA,IL,NC,IN,AZ,MN)"
CoreSource (OH)
Country Life Insurance Company
Covenant Administrators (TPA)
Coventry Carelink Medicaid
CoventryCares of Maryland
CoventryCares of Michigan
CoventryCares of Nebraska
CoventryCares of Pennsylvania
Coventry Healthcare - Diamond Plan
Coventry Healthcare National Network
Coventry Health Care USA (HCUSA)
Cox Health Plan
CrystalRun Health Plans
CSA Fraternal Life Medicare Supp
CSI Life Insurance Company
Culinary Health Fund
Culinary Health Fund UNITE HERE Health
DakotaCare
Dean Health Plan
DeCare Dental Health Insurance
Definity Health
Delaware Medicaid
Delaware Physicians Care
Dell Childrens Health Plan
DeltaCare USA - Claims
DeltaCare USA - Encounters
Delta DentalIns. Co. - Alabama
Delta DentalIns. Co. - Florida
Delta DentalIns. Co. - Georgia
Delta DentalIns. Co. - Louisiana
Delta DentalIns. Co. - Mississippi
Delta DentalIns. Co. - Montana
Delta DentalIns. Co. - Nevada
Delta DentalIns. Co. - Texas
Delta DentalIns. Co. - Utah
Delta Dental of California
Delta Dental of Colorado
Delta Dental of Connecticut
Delta Dental of Delaware
Delta Dental of Hawaii
Delta Dental of Indiana
Delta Dental of Maryland
Delta Dental of Michigan
Delta Dental of Minnesota
Delta Dental of Nebraska
Delta Dental of New Jersey
Delta Dental of New Mexico
Delta Dental of New York
Delta Dental of North Carolina
Delta Dental of North Dakota
Delta Dental of Ohio
Delta Dental of Pennsylvania
Delta Dental of Rhode Island
Delta Dental of Tennessee
Delta Dental of Virginia
Delta Dental of Washington DC
Delta Dental of Washington State
Delta Dental of West Virginia
DentalBenefit Providers
Denver Health Medical Plan
Deseret Mutual(DMBA)
Devoted Health FL
Director's Guild
District 9 IA of MAW Welfare Trust
District of Columbia Medicaid
Driscoll Health Plan
EBMS
Educators MutualInsurance (EMI)
Elderplan
Emblem Health
Employee Benefit Services - Dental
Empower Arkansas
Equitable Life Casualty Insurance Company
Essence Healthcare
Evercare
Everence Financial
Everest Reinsurance Company
Evergreen Health Co-Op
Expert Benefit Solutions
Fallon Community Health Plan
Farm Bureau Health Plans
FCE Benefit Administrators
Federated Insurance Company
Fidelis Care New York
FirstCare
First Carolina Care
First Community Health Plan
First Health Network (Coventry National)
First Medical Network
First United American Ins.Co
Flex Compensation - Dental
Florida Combined Life - DENTAL
FLORIDA HEALTH CARE PLANS
Florida Medicaid
Florida True Health
Food Employers & Bakery
Freedom Blue
Fresenius Health
Fresenius MedicalCare
Fringe Benefits
Gateway Health Plan
Geisinger Health Plan
Geisinger Health Plan Gold
Generations Healthcare
Georgia Medicaid
GHI
Gilsbar
Globe Life & Accident Ins.Co.
Golden Rule Insurance
Government Employees Hospital Association (GEHA)
Great American Life Insurance Co. Medicare Supp
Great Southern Life Insurance Company
Greek Catholic Union of the USA
Group Hospitalization and Medical Services
Group Practice Affiliates
Guardian Life Insurance Co. of America - Dental
Harken Health
Harmony Health Plan
Hawaii Medicaid
Hawaii Medical Assurance Association
Health Alliance Medical Plan (IL)
Health Alliance Medical Plans (HAP)
Health America of PA
Healthcare Highways
Health Choice Arizona
Health Choice Oklahoma
HealthComp Administrators
Health Cost Solutions
HealthEase
HealthEase Kids
HEALTHe Exchange
Health First Health Plan
Health First Insurance
Healthfirst New York
Healthfirst of New Jersey
Healthgram (Primary PhysiciansCare)
Healthkeepers (Anthem)
HealthMarkets (Chesapeake National Life)
HealthMarkets (Mega Life and Health Insurance)
HealthMarkets (Mid-West National Life)
HealthMarkets (TransAmerica Life)
Health Net National
Health New England
HealthNow
Health Partners of MN
Health Partners of Philadelphia
Health Partners Pennsylvania
HealthPlan of Nevada
Health Plan of San Mateo
Health Plan of Upper Ohio Valley
Healthplan Services - Celtic Insurance Company
HealthPlans Inc
HealthPlus of Michigan
HealthScope
HEALTH SERVICES CHILDREN SPECIAL NEEDS
Health Share of Oregon
HealthSmart Benefit Solutions
HealthSmart Benefit Solutions (Wells Fargo TPA)
Healthsource Provident - Dental
HealthSpring
Healthteam Advantage
Heartland National Life Insurance Company
Heritage Physician Network (Houston)
Hershey Healthsmile - Dental
Highmark Senior Solutions Company
HIPNY
HMA Hawaii Mainland Admin
Hometown Health
Horizon NJ Health
HSBS Memphis
HSBS Oklahoma City
Humana
Humana CareSource (KY)
Humana Dental
IBM Insurance Outsourcing Services
iCare (Independent Care Health Plan)
iCare Independent Care Health Plan
Idaho Medicaid
IHC Health Solutions
Illinois Medicaid
Independence Administrators Yes
Independent Health
Indiana Medicaid
Indiana University Health Plan Medicare
Indiana University Health Plans Commercial
Inland Empire Health
Insurers Administrative Corporation (IAC)
Integrated Mental Health Services
Inter Valley Health Plan
Iowa Medicaid
Iowa Total Care
Island Home Insurance
Jackson Memorial Hospital Health Plan
John Hopkins Health Plan
Johns Hopkins HealthCare LLC
Johns Hopkins US Family Health Plan MD
Kaiser Foundation Health Plan of Colorado
Kaiser Foundation Health Plan of Hawaii
Kaiser Foundation Health Plan of Hawaii(DHMO Choice)
Kaiser Foundation Health Plan of the Mid-Atlantic
Kaiser Foundation Health Plan of the Northwest
Kaiser Foundation Health Plan of Washington
Kaiser Permanente of Georgia
Kaiser Permanente of Northern CA
Kaiser Permanente of Southern CA
Kansas Medicaid
Katy Medical Group
Kentucky Medicaid
Kentucky Passport
Key Benefits Administrators (IN)
Keystone First Community Health Plan
Keystone Mercy Health
Keystone VIP Care
Kitsap Physician Services
KSKJ Life
LA CARE HEALTH PLAN
Leggett & Platt
Leon MedicalCenters Health Plan
Leon MedicalCenters Health Plans
Liberty National Life Ins.Co.
Lifetime Benefit Solutions (RMSCO)
Lifewise Arizona
Lifewise Health Plan of Oregon
Lifewise Health Plan of Washington
Lincoln Financial
Lincoln Heritage
Local 1199
LoneStar TPA
Loomis Company
Louisiana Health Exchange
Louisiana Medicaid
Loyal American Life Insurance Co. Medicare Supp
Lumico Life Insurance
Magellan Behavioral Health
Magellan Complete Care of Virginia
Magnacare
Maine Medicaid
MAMSI Health Plan
Managed Care of America
Managed Care Systems CA
Managed Health Network (MHN)
MAPFRE Life Puerto Rico
Maricopa Care Advantage (Arizona)
Maricopa Health Plan (Arizona)
Martin's Point
Maryland Medicaid
Massachusetts Medicaid
MedBen
MedCost Benefit Services
Medica2 Individual Family
Medica Health Plans
Medicaid
Medica Insurance
Medical Associates Health Plan/Health Choices
MedicalCard System
Medical Mutual of Ohio
Medicare
Medicare y Mucho Mas (INMEDIATA HEALTH GRP CORP)
Medigold Health Plans
Med-Pay Inc
MedStar Family Choice
MedStar Health Plan
Mega Health
Mega Life (Oklahoma City)
Mercy Care Plan (Arizona)
Meridian Health Plan of Illinois
Meritain Health
Meritus Health Partners
MetLife Dental Family
MetroPlus Health Plan
Metropolitan Health Plan (MHP)
MHNET Behavioral Health
Michigan Medicaid
Michigan Medicaid Pending Eligibility
Michigan MIChild
Minnesota Medicaid
MississippiChildren's Health Insurance Program
Mississippi Medicaid
Mississippi State Employees and Teachers
MissouriCare
Missouri Health Plan (Community & State)
Missouri Medicaid
MMM of Florida
MMSI (Mayo Health)
Moda Health
Molina Healthcare of California
Molina Healthcare of Florida
Molina Healthcare of Idaho
Molina Healthcare of Illinois
Molina Healthcare of Michigan
Molina Healthcare of New Mexico
Molina Healthcare of Ohio
Molina Healthcare of Puerto Rico
Molina Healthcare of South Carolina
Molina Healthcare of Texas
Molina Healthcare of Utah
Molina Healthcare of Washington
Molina Healthcare of Wisconsin
Montana Medicaid
Municipal Health Benefit Fund
Mutual Health Services
Mutual of Omaha
Mutual of Omaha Medicare Advantage
MVP Health Care (New York)
"NaphCare,Inc."
National Association of Letter Carriers (NALC)
National Telecommunications Cooperative Association (NTCA)
Nebraska Medicaid
Nebraska TotalCare
NEHEN - Harvard Pilgrim Health Care
NEHEN - Neighborhood Health Plans
Neighborhood Health Partnership
Neighborhood Health Plan (RI)
Network Health Insurance Corp
Network Health Plan of WI
Nevada Medicaid
New Era Life Insurance Co.
New Hampshire Medicaid
New Jersey Medicaid
New Mexico Medicaid
New York Medicaid
North Carolina Medicaid
North Dakota Medicaid
Northwest Administrators
Nova Healthcare Administrators
NovaSys Health
Ohana Health Plan
Ohio Medicaid
Oklahoma Employees Group Insurance Division
Oklahoma Medicaid
Operating Engineers Local No.428
Optima/Sentara
Orange County Fire Authority
Oregon Medicaid
Oscar (NY)
Oxford Health Plans
Pacificare Washington
PacificSource Administrators
PacificSource Community Solustions Medicaid
Pacific Source Health Plan
PacificSource Medicare
Pan-American Life Insurance
Panamerican Life Puerto Rico (PALIC)
Paramount Health
Partnership Health Plan of California
Partners National Health Plans of NC
Patriot Dental
Pennsylvania Health and Wellness
Pennsylvania Medicaid
Penn Treaty Network America Ins Medicare Supp
Peoples Health
Perkin Life Insurance
PersonalInsurance Administrators (PIA)
Phoenix Health Plan
Physicians Health Plan Northern IN
Physicians Health Plan of Mid-Michigan
Physicians MutualInsurance Company
Physicians Plus Insurance Corp
Piedmont
Pinnacle Claims Management
Pinnacle Physician Management Org
Plan de Salud Hospital Menonita
Planned Administrator Inc
POMCO
Preferred Care Partners
Preferred Medicare Choice(PMC)(INMEDIATA HEALTH GRP)
PreferredOne
Premier Health
PRESBYTERIAN HEALTH PLAN
Prestige Health Choice
PrimeWest Health
Principal Financial Group (Nippon Life)
Principal Life (Principal Life Financial Group)
Priority Health
ProfessionalBenefits Administrators
Prominence Health Plan of Nevada
Prominence Health Plan of Texas
Providence Health Plan
Provident American Life & Health Ins. Co. Mcare Supp
Provident Preferred Network - Dental
Public Employees Health Program
Puerto Rico Medicaid
Puritan Life Insurance
Qualcare
Qualchoice
QuikTrip Corporation
Recall Systems - Boon-Chapman Benefit Admin
Recall Systems - Corporate Benefit Service
Recall Systems - Group & Pension Administrators
Recall Systems - Underwriters Safety & Claims
Reserve NationalInsurance Company
Rhode Island Medicaid
RiverLink Health
Rocky Mountain Health Plan
Royal Neighbors of America
S and S Healthcare Strategies
Sanford Health Plan
San Francisco Health Plan
San Joaquin Health Plan
Santa Clara Family Health Plan
Schaller Anderson Aetna Better Health of New York
Schaller Anderson Aetna Better Health OH
"Schaller Anderson Delaware Physicians, Inc"
Schaller Anderson MajestaCare Virginia
Schaller Anderson Maryland Physicians Care
Schaller Anderson Mercy Care
Schaller Anderson Mercy Maricopa
Schaller Anderson MissouriCare
Schaller Anderson Parkland Community Health Plan
Schaller Anderson Texas CHRISTUS
Scott and White Health Plan
Secure Health Plans of Wisconsin
Securian Dental
Securian/Patriot Dental
Security Health Plan
SelectCare of Texas (Beaumont)
SelectCare of Texas (Golden Triangle)
SelectCare of Texas (Houston)
SelectCare of Texas (Integranet)
SelectCare of Texas (Kelsey-Seybold)
SelectCare of Texas (MemorialClinical Assoc)
SelectCare of Texas (Northwest Diagnostic)
Select Health SC
Select Health Utah
Select Senior Clinic
Selman & Company
Sendero IdealCare
Senior Care Action Network (SCAN) HMO
Senior Health Services Center-Univ American Family Co.
Senior Whole Health
Sharp Health Plan
Shenandoah Life Insurance
Sierra Health Services
Significa Benefit Services
SilverSummit Health Plan
Simply Healthcare Long Term Care
Simply Healthcare Plans
SisCo Benefits
Soundpath Health
South Carolina Medicaid
South Country Health Alliance
South Country Health Alliance Medicaid
South Dakota Medicaid
Southeastern Indiana Health Organization
Southern Health Services
Special Agents MutualBenefit Assoc
Spectrum Health
SPJST Medicare Supplement
Standard Life and Accident Insurance
State Farm
State Mutual(Lincoln Novation)
State Mutual Med Supp
StayWell
Staywell Kids
Stewart C Miller and Co
Stonebridge Life Insurance Company
StudentResources
SummaCare Health Plan
Summit America Insurance Service
Summit Community Care
Sunflower State Health (Kansas)
Sutter Health Plus
Sutter Select
TennDent
Tennessee Medicaid
TexanPlus (Integranet)
TexanPlus (Kelsey-Seybold)
TexanPlus North Texas Area
TexanPlus Southeast Texas Area
Texas First Health Plan (TOPA)
Texas Medicaid
Texas Medicaid - Long Term Care
The Kempton Company
The ULLICO Family of Companies
Three Rivers Health Plans (Unison Health Plan)
Thrivent
Today's Health
Today's Option
TransactRX Infusion and Specialty
TransactRX Part D
TransAmerica Admin by KBA
Transamerica Premier Life Insurance Company
"Triad Healthcare, Inc"
Tribute-SelectCare of Oklahoma
Tricare East
TRICARE for Life
TRICARE Overseas
Tricare West
TRICARE West formerly North
Trillium Community Health Plan
Triple S Advantage Puerto Rico
Triple-S Salud BCBS Puerto Rico
Trustmark Insurance
Tufts Health Plan
UCare of Minnesota
Ultimate Health Plans
UMR
UNICARE - Dental
Unicare (Wellpoint)
Union Pacific Railroad Employees Health Systems
United American Ins.Company
"United Concordia Companies, Inc. - DENTAL"
United Concordia Federal Employees Program - DENTAL
United Healthcare
United Healthcare Community Plan - Kansas
United Healthcare Community Plan - Missouri
"United Healthcare Community Plan (OH,PA,SC)"
United Healthcare Community Plan - Tennessee
United Healthcare Facets Detroit Community and State
United Healthcare Facets Pittsburgh Community and State
United Healthcare Nevada Market
United Healthcare Plan of River Valley
United Healthcare SecureHorizons
United Healthcare Student Resources
United Mine Workers UMWA
United Teacher Assoc Insurance Co. Mcare Supp
Unity Health Plans
Univera
Universal American
UniversalBenefit Corp
University Care Advantage Arizona
University Family Care
University of Arizona Health Plans - UHM
University of Utah Health Plans
University Physicians Care Advantage (Arizona)
University Physicians Healthcare Group (Arizona)
UPMC Health Plan (Tristate)
USAA Life Insurance Company
Utah Medicaid
VA Fee Basis Program
VA Health Administration Center
VA Healthcare
Valley Care Program
Valley Health Plan
"Vantage Health Plan,Inc"
Vermont Medicaid
Village Family Practice
Virginia Medicaid
VIVA Health
VNS CHOICE
Vytra
Washington Medicaid
Washington National
WEA Trust
"WEB-TPA, Inc"
Wellcare Health Plans
Wellsense
Western Health Advantage
West Virginia Medicaid
Wilson McShane - Dental
Windsor Health Plan
Windsor Medicare Extra
Wisconsin Medicaid
Wisconsin Medicaid Chronic Disease Program
Wisconsin Medicaid Well Woman Program
World Corp
World Insurance (ARIC)
WPS Health Insurance
Wyoming Medicaid
YourCare Health Plan
Custom/Other Insurance Provider Name
Verification of custom insurance providers is not guaranteed
Member ID
Group Number (Optional)
Medical Insurance Card - FRONT
Please take a photo of the front of your insurance card and upload.
Medical Insurance Card - BACK
Please take a photo of the back of your insurance card and upload.
SUBMIT
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