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| CHIP Member Handbook |
| Explanation of Benefits, Evidence of Coverage
and Disclosure Form - September 2006 |
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| Molina Member Identification Card (ID) |
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How to read your ID card:
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| Front |
Back |
| Name of Health Plan |
Member Services Contact Information |
| Program Name - STAR or CHIP |
Directions for Emergency Services |
| Member Name |
Referral Service Information |
| Member Identification Number/Date of Birth |
Behavioral Health Contact information |
| Name of Primary Care Physician |
Vision Services |
| Phone Number for Primary Care Physician |
Provider Services |
| Effective Date of Primary Care Physician |
Prescription Services |
| Co-pays Amounts |
Claims Submission Information |
| Date the ID Card Was Issued |
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| How to use your ID card: |
| Show your ID card whenever you are getting health care. |
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| How to replace a lost or stolen ID card: |
| If your ID card has been lost or stolen call Member Services for a
new ID Card.
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