Member Materials

Request Your Summary of Benefits & Coverage
Please complete the form below and select whether you would like your SBC sent via email or mailed to your street address. You may also request your SBC by calling Member Service at (800) 545-5015.

Member Information
* Indicates required field
*First Name
*Last Name
*Date of Birth (01/01/1970):

*Member Number

*Phone Number

*How should we send your SBC?
Email Mail