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The Back of the ID Card The back of the ID Card includes network information and SelectHealth contact information. © 2016 SelectHealth. All rights reserved. 4862 02/16 IN-NETWORK BENEFITS Medical Ded: None Urgent Care: $40 Office PCP/SCP: $5/$40 Emergency Room: $65 Preventive PCP/SCP: $0/$0 Member: JOHN DOE Member ID: 800000000 Rx BIN: 015938 Rx PCN: 7463 Rx GRP ID: GXXXXXXX H1994 002 SAMPLE JOHN DOE ID: 800000000 Participating Benefits Medical Ded: $250 Office PCP/SCP: $15/$25 Preventive PCP/SCP:* $0 ER Participating:* $100 InstaCare: $25 ER Nonparticipating:* $250 *After medical deductible Rx: $10/$25/$45 SAMPLE Utah ID Card Guide These ID Card samples will help you identify SelectHealth® members. Our Member Services representatives are available to answer your questions about benefits and eligibility. Call us at 800-538-5038 weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. COMMERCIAL NETWORKS MEDICARE ADVANTAGE Questions? Call Member Services: 801-442-5038 (SLC), 800-538-5038 Hours: Mon. - Fri. 7:00 a.m. to 8:00 p.m. and Sat. 9:00 a.m. to 2:00 p.m. Need a healthcare provider? Call SelectHealth Member Advocates: 801-442-4993 (SLC), 800-515-2220 Outside of Utah? Use MultiPlan or PHCS Providers. Call 800-678-7427 Life-threatening Emergencies? Covered anywhere. Call Member Services within 48 hours if you use nonparticipating providers or facilities. THIS CARD DOES NOT GUARANTEE COVERAGE. P.O. Box 30192, Salt Lake City, UT 84130-0192 BIN: 800008 selecthealth.org SAMPLE MEDICAID Questions? Call Member Services: 800-538-5038 Hours: Mon. - Fri. 7:00 a.m. to 8:00 p.m. and Sat. 9:00 a.m. to 2:00 p.m. Need a healthcare provider in Utah or Idaho? Call SelectHealth Member Advocates: 800-515-2220 Need a healthcare provider outside of Idaho and Utah? Call MultiPlan: 800-678-7427 Life-threatening Emergencies? Covered anywhere. Call Member Services within 48 hours if you use nonparticipating providers or facilities. THIS CARD DOES NOT GUARANTEE COVERAGE. P.O. Box 30192, Salt Lake City, UT 84130-0192 BIN: 800008 selecthealth.org SELECTHEALTH NETWORKS Members can view, email, and fax ID Card images using the SelectHealth mobile app. Rx: $10/25%/50% Rx Ded: None JOHN DOE ID: 800000000 Participating Benefits Medical Ded: $600 Office PCP/SCP: $25/$50 Preventive PCP/SCP: $0/$0 ER Participating: *$100 Urgent Care Clinic: $50 ER Nonparticipating: *$100 *After medical deductible SAMPLE JOHN DOE ID: 800000000 Participating Benefits Medical Ded: $250 Office PCP/SCP: $15/$25 Preventive PCP/SCP:* $0 ER Participating:* $100 InstaCare: $25 ER Nonparticipating:* $250 *After medical deductible SAMPLE Rx: $10/$25/$45 SAMPLE Only the state-issued ID card is required for SelectHealth Community Care® members to access services. Verify eligibility at medicaid.utah.gov/ eligibility-lookup-tool or by calling AccessNow at 801-538-6155.
