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  • Id Number Member Id Group Number Date Of Birth Date Of Birth

Get Id Number Member Id Group Number Date Of Birth Date Of Birth

Prescription Drug Claim Form Connecticut General Life Insurance Company CIGNA Health and Life Insurance Company REASON FOR REIMBURSEMENT This claim form can be used to request reimbursement of covered.

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How to fill out the ID number member ID group number date of birth date of birth online

Filling out the ID number member ID group number date of birth date of birth form online can seem daunting, but it is a straightforward process. This guide will walk you through each component to ensure that your information is complete and accurate.

Follow the steps to accurately complete your form online.

  1. Click ‘Get Form’ button to access the form and open it in your chosen editing tool.
  2. Locate the ID number field. Enter your unique identification number. This number is often assigned by the relevant organization and ensures your record is accurately matched.
  3. Proceed to the member ID section. Here, input your member identification number, which is typically provided by your insurance or membership organization.
  4. Next, find the group number field. Enter the group identification number associated with your membership plan or insurance group. This number helps to identify specific group memberships.
  5. Now move to the date of birth section. Enter your birth date in the required format (usually MM/DD/YYYY). Ensure this information is accurate as it may be used for identification purposes.
  6. Review all the fields for accuracy. Make sure that all the entered information is correct and corresponds to the provided documents.
  7. Once all the fields have been filled out and checks for accuracy are complete, you can save your changes, download the form for future reference, print it, or share it as needed.

Start filling out your documents online now for efficiency and convenience.

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Member ID Number: identifies you, the insured. Group number: Identifies your employer plan. Each employer choses a package for their employees based on price, or types of coverage. This is identified through the group number.

If you have any questions, call Provider Services at (855) 322-4082.

Like your individual policy number, the group number on your insurance card is a code assigned to your employer's insurance plan. Insurance group numbers help insurance companies identify the benefits included in your employer's plan and process claims effectively.

Your member number, also known as your identification number, is listed directly below your name. You'll need this information when receiving medical services at the doctor or pharmacy, or when calling customer service for assistance.

Contact Information Provider ServicesPhone (855) 322-4082 Fax (425) 424-1172 / (877) 814-0342ClaimsPhone (855) 322-4082 PO Box 22612 Long Beach, CA 90801Member ServicesPhone (800) 869-7165 Fax (800) 816-3778Mailing AddressMolina Healthcare of Washington PO Box 4004 Bothell, WA 98041-40041 more row • Jun 11, 2020

Molina's BHSO health plan is designed to provide Washington Apple Health (Medicaid) Fee-for-service members with mental health and substance use disorder treatment services. Together with our behavioral health providers, our goal is to help keep you well. Learn more.

Call Member Services at (844) 809-8438, TTY/TDD: 711.

To verify the status of your Claims, please use the Provider Portal or by accessing the automated IVR functionality. For other Claim questions you can call the Contact Center at (855) 322-4082.

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Get ID Number Member ID Group Number Date Of Birth Date Of Birth
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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
ID Number Member ID Group Number Date Of Birth Date Of Birth
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