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Letter & ID Card

Maharishi International University
Group # ST0869SH



Important Information - Please Read Carefully

Thank you for participating in the Student Health Insurance Plan (SHIP) administered by Wellfleet Group, LLC.

Attached you will find your health insurance ID card. Please keep this card with you and always present it whenever you seek medical treatment in order to assure proper coverage for services. This card can be used for the entire term of your enrollment in the health plan. All claims should be forwarded to the address specified on your ID Card.

To learn about your Student Health Insurance Plan please visit www.wellfleetstudent.com, and select your school. We recommend you visit this site periodically to stay up to date on your plan. Your school page will provide you with important information such as:

* Carrier Privacy Notices, Disclosures and Important Alerts
* Plan documents such as Benefits at a Glance and Certificates of Coverage
* Access to your electronic ID Card, claims information and Explanation of Benefits documents
* Links to a directory of Network Providers contracted to provide discounted rates for health care services
* Links to additional services such as pharmacy benefits and formularies, behavioral health counselors, nurse
hotlines, and emergency travel assistance services (if included in your plan)
* Plus value added services such as discount dental and vision programs available to you as a Wellfleet member

We encourage you to create/access your account using the My Account link on the school page and verify/update your personal information by selecting the Student Options tab once you have signed in to the system.

Please review the plan documents to understand the benefits and exclusions of your plan. You can reach us by using the Contact Us link on our website, by email at customerservice@wellfleetinsurance.com, or by phone at (877) 657-5030 with any questions you may have about your plan, its benefits, exclusions and claims.

Thank you for your participation and welcome to Wellfleet.

PHCS PPO is the Provider Network supporting your Student Health Insurance Plan.
Wellfleet Group, LLC is the Plan Administrator.
This plan is fully insured by Commercial Casualty Insurance Company.



Contact Information:
Eligibility/Claims: (877) 657-5030
*Travel Assistance Services Only:
Inside US/Canada: (877) 305-1966
International Call: (715) 295-9311
Away From Home Care Logo
Wellfleet Nurseline 24/7: (800) 634-7629
Pre-certification required-call Hines: (888) 893-7264 Pre-certification does not guarantee coverage or payment
Forward all Claims & Correspondence to:
Wellfleet Group, LLC
PO Box 15369
Springfield, MA 01115-5369
EDI Payer ID: 87843
wellfleetinsurance.com


To Locate a
PHCS/Multiplan Provider:
PHCS: (800) 922-4362
Multiplan: (888) 342-7427
multiplan.com


Wellfleet Insurance Company
Possession of card does not guarantee coverage
Member
BYAMBADORJ DULAMSUREN
ID: 001788609      00
ST0869SH - Maharishi International University


Benefits
Wellfleet Rx/ESI - Rx Copay: Tier 1: $25, Tier 2: $50, Tier 3: $75
RX BIN: 003858 Pharmacist Rx Help Desk: (800) 922-1557
PCN: A4 Member Pharmacy Help Desk: (877) 640-7940
RxGroup: WFLEET1


CareConnect Behavioral Health Hotline: (888) 857-5462
Eligibility/Claims: (877) 657-5030 **No Referral Required**
See Reverse Side For Important Information