Notes

Date Requested : 2019-02-07

First Name : DONNIE
Middle Name : L
Last Name : JOYCE
Gender : M
DOB : 1953-05-05
Address 1 : 420 COURTLAND ST NE
Address 2 :
City : ATLANTA
State : GA
Zip : 303083405

Subscriber ID : 255885071M

Health Benefit Plan Coverage

Medicare Part A
- Inactive :

Medicare Part B
- Active Coverage :
- DeductibleCalendar Year : $185
- DeductibleRemaining :
- Co-InsuranceVisit :

Insurance Information
- AETNA LIFE INSURANCE COMPANY (Pharmacy)
1457512428
BB KB
6787512823
Date Requested : 2019-02-07

First Name : BRENDA
Middle Name : F
Last Name : FLEENOR
Gender : F
DOB : 1956-01-10
Address 1 : 12 CLINCH MOUNTAIN RD
Address 2 :
City : LEBANON
State : VA
Zip : 242665753

Subscriber ID : 5YV0Q00TA15

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- ReserveLifetime :
- ReserveLifetime Remaining :

Qualified Medicare Beneficiary
- DeductibleEpisode :
- Co-PaymentEpisode :
- Co-PaymentDay :
- Co-PaymentEpisode :
- Co-PaymentDay :
- ReserveDay :
- DeductibleCalendar Year :
- Co-InsuranceVisit :

Medicare Part B
- Active Coverage :

Insurance Information
- SILVERSCRIPT INSURANCE COMPANY (Pharmacy)
BB
2763457721
1457512428

Date Requested : 2019-02-07

First Name : AUDRA
Middle Name : A
Last Name : RAY
Gender : F
DOB : 1968-02-04
Address 1 : 315 E 102ND ST APT 907
Address 2 :
City : NEW YORK
State : NY
Zip : 100295682

Subscriber ID : 7UQ2A31JD22

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- ReserveLifetime :
- ReserveLifetime Remaining :

Qualified Medicare Beneficiary
- DeductibleEpisode :
- Co-PaymentEpisode :
- Co-PaymentDay :
- Co-PaymentEpisode :
- Co-PaymentDay :
- ReserveDay :
- DeductibleCalendar Year :
- Co-InsuranceVisit :

Medicare Part B
- Active Coverage :

Insurance Information
- SILVERSCRIPT INSURANCE COMPANY (Pharmacy)
KB
9175014472
Date Requested : 2019-02-07

First Name : CHARLENE
Middle Name : L
Last Name : HOFFMAN
Gender : F
DOB : 1940-06-12
Address 1 : 2000 BEAUMONT RD
Address 2 :
City : BAYTOWN
State : TX
Zip : 775203114

Subscriber ID : 195300456A

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- ReserveLifetime :
- ReserveLifetime Remaining :

Qualified Medicare Beneficiary
- DeductibleEpisode :
- Co-PaymentEpisode :
- Co-PaymentDay :
- Co-PaymentEpisode :
- Co-PaymentDay :
- ReserveDay :
- DeductibleCalendar Year :
- Co-InsuranceVisit :

Medicare Part B
- Active Coverage :

Insurance Information
- WELLCARE PRESCRIPTION INSURANCE, INC. (Pharmacy)
8324430058

Date Requested : 2019-02-07

First Name : GENEVA
Middle Name : G
Last Name : CORBY
Gender : F
DOB : 1934-12-22
Address 1 : 6415 DURLAND RD
Address 2 :
City : GLEN ST MARY
State : FL
Zip : 320403307

Subscriber ID : 9YD1D45TG96

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- Benefit Description :
- DeductibleEpisode : $1364
- DeductibleEpisode : $1340
- DeductibleRemaining : $1364
- DeductibleRemaining : $1340
- DeductibleRemaining :
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- Co-PaymentEpisode :
- Co-PaymentDay : $335
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- Co-PaymentEpisode :
- Co-PaymentDay : $335
- Co-PaymentEpisode :
- Co-PaymentDay : $335
- ReserveLifetime :
- ReserveLifetime Remaining :
- ReserveDay : $682
- ReserveDay : $670

Medicare Part B
- Active Coverage :
- DeductibleCalendar Year : $185
- DeductibleRemaining : $140.72
- Co-InsuranceVisit :

9042592749
1194709725

Date Requested : 2019-02-07

First Name : WILLIAM
Middle Name : L
Last Name : ALLEN
Gender : M
DOB : 1947-08-23
Address 1 : 1674 COLONIAL ST
Address 2 :
City : SHAKOPEE
State : MN
Zip : 553794462

Subscriber ID : 6N02MY6HG04

Health Benefit Plan Coverage

Medicare Part A
- Active Coverage :
- DeductibleEpisode : $1364
- DeductibleRemaining : $1364
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- Co-PaymentEpisode :
- Co-PaymentDay : $341
- ReserveLifetime :
- ReserveLifetime Remaining :
- ReserveDay : $682

Medicare Part B
- Active Coverage :
- DeductibleCalendar Year : $185
- DeductibleRemaining : $185
- Co-InsuranceVisit :

Preferred Provider Organization (PPO)
- Contact Following Entity for Eligibility or Benefit Information :
- Name : HUMANA INSURANCE COMPANY
- Address 1 : 1100 Employers Boulevard
- Address 2 :
- City : DePere
- State : WI
- Zip : 54115
- Contact Info :
8004486262
www.humana.com/medicare

Insurance Information
- HUMANA INSURANCE COMPANY (Pharmacy)
- HUMANA INSURANCE COMPANY (Health Benefit Plan Coverage)

9526579621
1245291566
BB