RUN_DATE DATA_SEQ_NO CLIENT_NUMBER UHG_TYPE DOC_ID DOC_SEQ_ID NAME MAILSET_NUMBER BARRETT 9452809/000001-00 9452809/000001-01 9452809/000001-02 DIG2CARD 20110607 0000001 0000001 003113 0000001 10:53:48 ,WILLIAM 003113 This card is recognized wherever you go and entitles the card holder to the benefits specified in the agreement pursuant to which this card is issued. While other independent Blue Cross and Blue Shield Plans who belong to the Blue Cross and Blue Shield Association may assist the card holder in obtaining benefits, the card holder recognizes that the agreement which controls the use of this card and which specifies the card holder's benefits is solely between the parties to such agreement and Blue Cross and Blue Shield of Illinois, an independent company operating under a license from the Blue Cross and Blue Shield Association to use the familiar Blue Cross and Blue Shield names and service marks in the State of Illinois. 001 BlueCross BlueShield of Illinois P.O. Box 7344 Chicago, IL 60680-7344 9452809 Attached are your new ID cards. Please discard any previously issued card(s). Always present your most current ID card to the hospital or provider when you or your covered dependents seek health care. >000001 TEST =221014215228= www.bcbsil.com Subscriber Name: ABC SAMPLE Identification Number: 123456789 Group Number: 123456 Pre-notification: Call one day before inpatient or skilled nursing facility admission, receiving home health care or private duty nursing services; and within two days of an emergency, maternity or for a mental health/substance abuse admission. Provider: File medical claims with your local BCBS Plan. Customer Service Pre-Notify Med Pre-Notify MH/SA Provider Locator 24/7 Nurseline 1-800-828-3116 1-800-635-1928 1-800-851-7498 1-800-810-2583 1-800-299-0274 BlueCross BlueShield of Illinois, an independent licensee of the BlueCross BlueShield Association, provides claims processing only and assumes no financial risk for claims. 0311394528090000000000100000011534 117 www.bcbsil.com Subscriber Name: ABC SAMPLE Identification Number: 123456789 Group Number: 123456 Shipper ID: 00000000 Shipping Method: DIRECT CARRIER: USPS Address: Pre-notification: Call one day before inpatient or skilled nursing facility admission, receiving home health care or private duty nursing services; and within two days of an emergency, maternity or for a mental health/substance abuse admission. Provider: File medical claims with your local BCBS Plan. Insert Insert Insert Insert Insert Insert #1 #3 #5 #7 #9 #11 Customer Service Pre-Notify Med Pre-Notify MH/SA Provider Locator 24/7 Nurseline 1-800-828-3116 1-800-635-1928 1-800-851-7498 1-800-810-2583 1-800-299-0274 BlueCross BlueShield of Illinois, an independent licensee of the BlueCross BlueShield Association, provides claims processing only and assumes no financial risk for claims. Insert Insert Insert Insert Insert Insert Cycle Date: 20110602 PDF Date: Tue Jun 07, 2011 @ 10:53:48 MaxMover: N #2 #4 #6 #8 #10 #12