IMPORTANT NOTICE******** Subscriber (and or Spouse) Name: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Subscriber (and/or Spouse) Name in the designated field at the top of the form. Ensure that you spell the names correctly for accurate identification.
Fill in the Address 1 and Address 2 fields, followed by City, State, and Zip code. This information is crucial for correspondence regarding your health coverage.
Next, input the Date of Notice, Benefits Termination Date, Election Rights Expire on dates accurately to ensure compliance with deadlines.
Enter your Subscriber or Member ID Number along with Group Number and Group Name as these are essential for processing your COBRA election.
Review all entered information for accuracy before submitting. Use our platform’s features to save your progress if needed.

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What is the subscriber name on my insurance card?

Your insurance company uses your policy number to track and process insurance claims and costs. Policy numbers may also be referred to as subscriber IDs or member ID numbers.

What is the difference between a member and a subscriber?

The same also clarifies the difference between subscriber and member. Subscribers are those who take the subscription by paying a recurring fee, whereas membership become members of a company or business by paying a one-time fee or joining for free. It needs customers to pay a regular fee.

Are the member ID and subscriber ID the same?

Member ID (also called a subscriber number or patient ID)the number providers need to verify coverage. Groupthe number identifies your employer plan; if you purchase health insurance through a Marketplace/Exchange, your card may not have a group number.