56985416

PO BOX 28
PO Box 8738

Julie M Jenkins
Dayton, Ohio 45401-8738

BROOKVILLE, OH 45309-0028
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Marketplace Low Deductible

Silver 3
Member: Dependents: OH 2021
Julie M Jenkins
Member ID
109751571-00
Health Plan
77552OH001020506
Payer ID: 31114

 $0  5%*
 $15    $25
MISC-OH(2021) *after deductible

Marketplace Low Deductible

Silver 3
Member: Dependents: OH 2021
Julie M Jenkins
Member ID
109751571-00
Health Plan
77552OH001020506
Payer ID: 31114

 $0  5%*
 $15    $25
MISC-OH(2021) *after deductible
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AM-EXCM-0653a

CareSource.com/marketplace
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Member Services: 1-800-479-9502
CareSource24® Nurse Advice Line: 1-866-206-4240
TTY Service for Hearing Impaired: 1-800-750-0750 or 711
NUMBERS
MEMBER

Dental (Ped Only) DentaQuest 1-855-388-6252

Vision (Ped Only) EyeMed 1-833-337-3129
Hearing TruHearing 1-866-202-2561
PROVIDER

Provider Services: 1-800-488-0134 | ESI: 1-800-419-5609

INFO

RXBin: 003858 | RxPCN: A4 | RxGrp: RXINN04

Medical Claims: P.O. Box 8730, Dayton, OH 45401-8730
Coverage provided through the Health Insurance Marketplace by CareSource Ohio, Inc.
CareSource.com/marketplace
‘’“”•–—˜™•™š›”•œš•žŸ—˜—œ››•–š ›˜—ž›¡•‘š• ›˜“¢£•¤›œ›¥”¦• “›§•–¨—“©”¦•š˜•¥œ™•
—••ª˜š “™›˜¦• “”“•’›•§›¤”“›•š˜•–—¨¨•«›©¤›˜•¬›˜ “–›”¡
Member Services: 1-800-479-9502
CareSource24® Nurse Advice Line: 1-866-206-4240
NUMBERS
MEMBER

TTY Service for Hearing Impaired: 1-800-750-0750 or 711

Dental (Ped Only) DentaQuest 1-855-388-6252
Vision (Ped Only) EyeMed 1-833-337-3129
Hearing TruHearing 1-866-202-2561
PROVIDER Provider Services: 1-800-488-0134 | ESI: 1-800-419-5609
INFO
RXBin: 003858 | RxPCN: A4 | RxGrp: RXINN04
Medical Claims: P.O. Box 8730, Dayton, OH 45401-8730
Coverage provided through the Health Insurance Marketplace by CareSource Ohio, Inc.
56985416