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Request a New ID Card

Note: You can print a copy of your ID Card immediately by signing-in to CARESnet, our Secure, 24/7 online access to benefit and claims information for members.
Member Information

required fieldindicates required field

Member Name: required field

ID Number: required field

Daytime Phone No: required field

e-Mail: required field

EHC Policy/Group No: required field

Dental Policy/Group No: required field

BC Life Policy/Group No: required field

At least one of the EHC Policy/Group No, Dental Policy/Group No or BC Life Policy/Group No is required and must be in the following format: (E/D)###### (e.g. E123456, D000888)
Reason for Request
required field

Additional Comments

   
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