Request Additional ID Cards

Primary Member Name*

First NameLast Name

Email*

example@example.com

Phone Number

Please enter a valid phone number.

ID Cards Requesting (check all that apply)*

Note: The following exceptions apply:

ALL Benefit Boost Subscription Plans only have Digital ID cards. You can access Benefit Boost ID cards on the Member Portal.

VSP Individual Vision Plan does not need an ID card. You just tell the provider you have VSP and they look you up.

All Supplemental Insurance is on the back of the Membership (UBA or HAA) ID cards (if applicable)

How many ID cards are you requesting?*

Please verify that you are human*