Request Benefit Materials

To ensure that you have the most recent plan materials you may request this information at any time. Allow 5-7 days for these materials to arrive.



*Member Number (on ID Card)  
Group Number
*Date of Birth  
*Member First Name  
*Member Last Name  
Middle Initial
*Member Address  
*City  
*State
*Zip  
*Phone Number  
*Member Email Address    
Choose From the Following