Healthpartners 2019 Sample Member ID Cards

Special Needs Basic Care

GRP: 4180 SITE: 0 PKG: HP260 7C 11C

Emergency & Urgently Needed Care For emergency situations, call 911 and/or get medical attention immediately. For medical advice call the CareLineSM nurse service any time at 612-339-3663 or 800-551-0859. ID 12345678 Group 4180 Renewal Mo. SM Hospital Admissions Contact CareCheck at 866-275-8555 for any Name JANE A DOE January admission at an out-of-network hospital or facility. Care Type HealthPartners Inspire SNBC PMI#### Claims Submission Medical: HealthPartners Claims, P.O. Box 1289, Minneapolis, MN 55440-1289 Office $0.00 Dental: HealthPartners Dental Claims, P.O. Box 1172, Minneapolis, MN 55440-1172 RxBIN 017142 RxPCN MNPROD1 See Contract Member Services RxGrp HMN07 Phone 952-967-7998 or 866-885-8880 (TTY 711) ER $0.00 HealthPartners Member Services P.O. Box 9463, Minneapolis, MN 55440-9463 Urgent $0.00 RideCare: To schedule a ride to a medical appointment, call 952-883-7400 or 888-288-1439. Deductible $0.00 To file a State Fair Hearing, please send your request to: Appeals Office/Department of Human Services, P.O. Box 64941, St. Paul, MN 55164-0941. Or, fax your request to: 651-431-7523. A State Ombudsman may be able to help you with your problem. They can also help you request a State Fair Hearing. You may call them at 651-431-2660 or toll free at 1-800-657-3729. healthpartners.com Offered by HealthPartners

GRP: 4182 SITE: 0 PKG: GPH07 Minnesota Senior Health41 Option (MSHO) 67

Emergency & Urgently Needed Care For emergency situations, call 911 and/or get medical attention immediately. For medical advice call the CareLineSM nurse service any time at 612-339-3663 Plan (80840) Renewal Mo. or 800-551-0859 or call your clinic at ###-###-####. ID 12345678 Group 4182 January Hospital Admissions Contact CareCheckSM at 866-275-8555 for any Name JANE A DOE PMI#### admission at an out-of-network hospital or facility. Care Type HealthPartners MSHO HMO SNP Claims Submission Medical: HealthPartners Claims, P.O. Box 1289, Minneapolis, MN 55440-1289 Office $0.00 Prescription Drug Plan Dental: HealthPartners Dental Claims, P.O. Box 1172, Minneapolis, MN 55440-1172 RxBIN 015574 RxPCN MNPROD1 See Contract Member Services RxGrp HMN01 Phone 952-967-7998 or 866-885-8880 (TTY 711) ER $0.00 HealthPartners Member Services P.O. Box 9463, Minneapolis, MN 55440-9463 Urgent $0.00 RideCare: To schedule a ride to a medical appointment, call 952-883-7400 or 888-288-1439. PCP Code PCP or Network CMS - H2422#### To file a State Fair Hearing, please send your request to: Appeals Office/Department of Human Services, Medical ABC ABC CLINIC P.O. Box 64941, St. Paul, MN 55164-0941. Or, fax your request to: 651-431-7523. A State Ombudsman may be able to help you with your problem. They can also help you request a State Fair Hearing. You may call them at 651-431-2660 or toll free at 1-800-657-3729. MS-ID Card GP051061 healthpartners.com Offered by HealthPartners

Medical Assistance GRP: 4183 SITE: 03 PKG: HMC4A 7C 11C

Emergency & Urgently Needed Care For emergency situations, call 911 and/or get medical attention immediately. For medical advice call the CareLineSM nurse service any time at 612-339-3663 or 800-551-0859. ID 12345678 Group 4183 Renewal Mo. SM Hospital Admissions Contact CareCheck at 866-275-8555 for any Name JANE A DOE January admission at an out-of-network hospital or facility. Care Type HealthPartners Care PMI#### Claims Submission Medical: HealthPartners Claims, P.O. Box 1289, Minneapolis, MN 55440-1289 Office $0.00 Dental: HealthPartners Dental Claims, P.O. Box 1172, Minneapolis, MN 55440-1172 RxBIN 017142 RxPCN MNPROD1 See Contract Member Services RxGrp HMN07 Phone 952-967-7998 or 866-885-8880 (TTY 711) ER $0.00 HealthPartners Member Services P.O. Box 9463, Minneapolis, MN 55440-9463 Urgent $0.00 RideCare: To schedule a ride to a medical appointment, call 952-883-7400 or 888-288-1439. Deductible $0.00 To file a State Fair Hearing, please send your request to: Appeals Office/Department of Human Services, P.O. Box 64941, St. Paul, MN 55164-0941. Or, fax your request to: 651-431-7523. A State Ombudsman may be able to help you with your problem. They can also help you request a State Fair Hearing. You may call them at 651-431-2660 or toll free at 1-800-657-3729. healthpartners.com Offered by HealthPartners

Minnesota Senior Care Plus (MSC+) with Medicare A and B GRP: 4184 SITE: 0 PKG: GSP03 7C 11C

Emergency & Urgently Needed Care For emergency situations, call 911 and/or get medical attention immediately. For medical advice call the CareLineSM nurse service any time at 612-339-3663 or 800-551-0859. ID 12345678 Group 4184 Renewal Mo. SM Hospital Admissions Contact CareCheck at 866-275-8555 for any Name JANE A DOE January admission at an out-of-network hospital or facility. Care Type HealthPartners Care PMI#### Claims Submission Medical: HealthPartners Claims, P.O. Box 1289, Minneapolis, MN 55440-1289 Office $0.00 Dental: HealthPartners Dental Claims, P.O. Box 1172, Minneapolis, MN 55440-1172 RxBIN 017142 RxPCN MNPROD1 See Contract Member Services RxGrp HMN07 Phone 952-967-7998 or 866-885-8880 (TTY 711) ER $0.00 HealthPartners Member Services P.O. Box 9463, Minneapolis, MN 55440-9463 Urgent $0.00 RideCare: To schedule a ride to a medical appointment, call 952-883-7400 or 888-288-1439. Deductible $0.00 To file a State Fair Hearing, please send your request to: Appeals Office/Department of Human Services, P.O. Box 64941, St. Paul, MN 55164-0941. Or, fax your request to: 651-431-7523. A State Ombudsman may be able to help you with your problem. They can also help you request a State Fair Hearing. You may call them at 651-431-2660 or toll free at 1-800-657-3729. healthpartners.com Offered by HealthPartners Minnesota Senior Care Plus (MSC+) with Medicare Part B only

GRP: 4186 SITE: 0 PKG: GSP05 7C 11C

Emergency & Urgently Needed Care For emergency situations, call 911 and/or get medical attention immediately. For medical advice call the CareLineSM nurse service any time at 612-339-3663 or 800-551-0859. ID 12345678 Group 4186 Renewal Mo. SM Hospital Admissions Contact CareCheck at 866-275-8555 for any Name JANE A DOE January admission at an out-of-network hospital or facility. Care Type HealthPartners Care PMI#### Claims Submission Medical: HealthPartners Claims, P.O. Box 1289, Minneapolis, MN 55440-1289 Office $0.00 Dental: HealthPartners Dental Claims, P.O. Box 1172, Minneapolis, MN 55440-1172 RxBIN 017142 RxPCN MNPROD1 See Contract Member Services RxGrp HMN07 Phone 952-967-7998 or 866-885-8880 (TTY 711) ER $0.00 HealthPartners Member Services P.O. Box 9463, Minneapolis, MN 55440-9463 Urgent $0.00 RideCare: To schedule a ride to a medical appointment, call 952-883-7400 or 888-288-1439. Deductible $0.00 To file a State Fair Hearing, please send your request to: Appeals Office/Department of Human Services, P.O. Box 64941, St. Paul, MN 55164-0941. Or, fax your request to: 651-431-7523. A State Ombudsman may be able to help you with your problem. They can also help you request a State Fair Hearing. You may call them at 651-431-2660 or toll free at 1-800-657-3729. healthpartners.com Offered by HealthPartners

GRP: 4187 SITE: 0 PKG: GSP07 Minnesota Senior Care7C Plus (MSC+) with Medicare Part A only 11C

Emergency & Urgently Needed Care For emergency situations, call 911 and/or get medical attention immediately. For medical advice call the CareLineSM nurse service any time at 612-339-3663 or 800-551-0859. ID 12345678 Group 4187 Renewal Mo. SM Hospital Admissions Contact CareCheck at 866-275-8555 for any Name JANE A DOE January admission at an out-of-network hospital or facility. Care Type HealthPartners Care PMI#### Claims Submission Medical: HealthPartners Claims, P.O. Box 1289, Minneapolis, MN 55440-1289 Office $3.00 Dental: HealthPartners Dental Claims, P.O. Box 1172, Minneapolis, MN 55440-1172 RxBIN 017142 RxPCN MNPROD1 See Contract Member Services RxGrp HMN07 Phone 952-967-7998 or 866-885-8880 (TTY 711) ER $0.00 HealthPartners Member Services P.O. Box 9463, Minneapolis, MN 55440-9463 Urgent $3.00 RideCare: To schedule a ride to a medical appointment, call 952-883-7400 or 888-288-1439. Deductible $0.00 To file a State Fair Hearing, please send your request to: Appeals Office/Department of Human Services, P.O. Box 64941, St. Paul, MN 55164-0941. Or, fax your request to: 651-431-7523. A State Ombudsman may be able to help you with your problem. They can also help you request a State Fair Hearing. You may call them at 651-431-2660 or toll free at 1-800-657-3729. healthpartners.com Offered by HealthPartners

Minnesota Senior Care Plus (MSC+) with no Medicare GRP: 4188 SITE: 0 PKG: GSP10 7C 11C

Emergency & Urgently Needed Care For emergency situations, call 911 and/or get medical attention immediately. For medical advice call the CareLineSM nurse service any time at 612-339-3663 or 800-551-0859. ID 12345678 Group 4188 Renewal Mo. SM Hospital Admissions Contact CareCheck at 866-275-8555 for any Name JANE A DOE January admission at an out-of-network hospital or facility. Care Type HealthPartners Care PMI#### Claims Submission Medical: HealthPartners Claims, P.O. Box 1289, Minneapolis, MN 55440-1289 Office $3.00 Dental: HealthPartners Dental Claims, P.O. Box 1172, Minneapolis, MN 55440-1172 RxBIN 017142 RxPCN MNPROD1 See Contract Member Services RxGrp HMN07 Phone 952-967-7998 or 866-885-8880 (TTY 711) ER $0.00 HealthPartners Member Services P.O. Box 9463, Minneapolis, MN 55440-9463 Urgent $3.00 RideCare: To schedule a ride to a medical appointment, call 952-883-7400 or 888-288-1439. Deductible $0.00 To file a State Fair Hearing, please send your request to: Appeals Office/Department of Human Services, P.O. Box 64941, St. Paul, MN 55164-0941. Or, fax your request to: 651-431-7523. A State Ombudsman may be able to help you with your problem. They can also help you request a State Fair Hearing. You may call them at 651-431-2660 or toll free at 1-800-657-3729. healthpartners.com Offered by HealthPartners

MinnesotaCare GRP: 4190 SITE: 0 PKG: HP 1 7C 65

Emergency & Urgently Needed Care For emergency situations, call 911 and/or get medical attention immediately. For medical advice call the CareLineSM nurse service any time at 612-339-3663 or 800-551-0859. ID 12345678 Group 4190 Renewal Mo. SM Hospital Admissions Contact CareCheck at 866-275-8555 for any Name JANE A DOE January admission at an out-of-network hospital or facility. Care Type HealthPartners Care PMI#### Claims Submission Medical: HealthPartners Claims, P.O. Box 1289, Minneapolis, MN 55440-1289 Office $25.00 Dental: HealthPartners Dental Claims, P.O. Box 1172, Minneapolis, MN 55440-1172 RxBIN 017142 RxPCN MNPROD1 See Contract Member Services RxGrp HMN07 Phone 952-967-7998 or 866-885-8880 (TTY 711) ER $75.00 HealthPartners Member Services P.O. Box 9463, Minneapolis, MN 55440-9463 Urgent $25.00 To file a State Fair Hearing, please send your request to: Appeals Office/Department of Human Services, Deductible $0.00 P.O. Box 64941, St. Paul, MN 55164-0941. Or, fax your request to: 651-431-7523. A State Ombudsman may be able to help you with your problem. They can also help you request a State Fair Hearing. You may call them at 651-431-2660 or toll free at 1-800-657-3729.

healthpartners.com Offered by HealthPartners