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Member / Resources & Self Service / Request a New ID Card

Request a New ID Card

Your ID Card should be shown each time you visit a provider’s office or facility.  A separate card will be issued for you and each of your covered dependents, upon your enrollment.  If you wish a replacement card to be issued for you and each of your covered dependents, you must submit the form below for each card you wish replaced.



Member Number (on ID card)
Group Number
*Member First Name  
*Member Last Name  
Middle Initial
*Address  
*City  
*State
*Zip  
*Phone Number  
*Member Email Address    
*Reason for Requesting
(lost, never received, etc.)		  
*Mail a new ID card to
First Name, Last Name, Member Number