| Front |
Back |
| Name of Health Plan |
Member Services Contact Information |
| Program Name - STAR+PLUS |
Service Coordination Phone Number |
| Member Name |
What to do in an Emergency |
| Member STAR Identification Number/Date of Birth |
Referral Service Information |
| Name of Primary Care Physician |
Behavioral Health Contact Information |
| Phone Number for Primary Care Physician |
Vision Benefit Contact Information |
| Effective Date of Primary Care Physician |
Provider Service Contact Information |
| Date the ID Card Was Issued |
Claims Submission Information |
