ALT IDMHC LINK 11/14 000001 Welcome to the Mountain Health CO-OP (MHC) Mountain Health CO-OP 1545 Iron Eagle Dr Ste 101 Eagle, ID 83616 If you have any questions about your benefits or membership, call Customer Service or visit us at www.mhc.coop/idaho/members 1 of 1 UTA-991600 For specific benefit details, refer to your plan benefit documents which can be found at www.mhc.coop/idaho/explore-plans >000001 00000 001 P11156 Please review the information on the card(s) for accuracy and contact our Customer Service Department at the number on the back of the card should you find any errors. XXXMEMBERXNAMEXXX 123 MAIN STREET ANYTOWN, PA 12345 Your new Member Identification card is attached. Please carry your card with you and present it when seeking health care services. We are here to help. Don’t hesitate to contact our Customer Service Department for assistance. {BeginExtract}ab57acfb-313c-4c65-8f07-57cccca8897e+ Members utilize the St. Lukes Health Partners / BrightPath / Altius Coventry National Network. This card does not constitute proof of eligibility, benefits or authorization of service. LINK Network Certain services require prior authorization. Failure to obtain authorization may result in no coverage. 1 of 1 Please coordinate your care with your Primary Care Physician (PCP). For urgent care outside of the LINK service area – seek appropriate medical care and contact your PCP for follow up care. Life Threatening Emergency – call 911 or go to the nearest emergency room. Member Name: xxxMEMBERxNAMExxx Member ID Number: xxMBRxNBR-XX Group Number: xxGRPxNBRx Plan Type: xxxxxPLANxxTYPExxxxxx PCP Network: ST. LUKES HEALTH PARTNERS Member Responsibility PCP OUTXX SPEC SPX UC UCX ER ERX DED BXXX RX RXxxxxxxxxxxxxx Urgent and Emergency care services will be reviewed for medical necessity Mental Health or Substance Abuse benefits – For prior authorization or immediate access to care, call MHNet at 800-701-8663 seven days a week, 24 hours a day. Pediatric Vision Benefits call VSP toll-free at 855-332-6193. Mountain Health CO-OP serviced by Altius, A Coventry Health Care Plan Medical Claims Address: P.O. Box 7147, London, KY 40742 Customer Service toll free: 855-488-0621 Hours: 8:00 AM to 6:00 PM (MT) Monday through Friday Customer Service email address: [email protected] Website: www.mhc.coop/idaho/members Emdeon EDI Number: 25133 Card Date: XX/XX/XXXX 000001 {EndExtract}ab57acfb-313c-4c65-8f07-57cccca8897e+ {Begin_Tag}ab57acfb-313c-4c65-8f07-57cccca8897e+