Sample Medicare Plus Blue PPO ID Card

Front of card                    Back of card

• Switch to PDP card
• Switch to MPSERS card
• Switch to UAW Retiree Medical Benefits Trust card

The Medicare Plus Blue card with the PPO logo shows that the member is enrolled in a preferred provider organization plan, but you should verify eligibility and coverage at every visit.

Legend

1. Member name – Each Medicare Plus Blue PPO and Prescription Blue PDP member gets a card in his or her own name.
2. Contract number – Identifies the member record in our files for health care services. XYL=MA PPO
3. If the member has prescription drug coverage, information for pharmacy to file a drug claim.
4. Customer Service phone numbers – If you have questions about coverage or claims, call the appropriate Customer Service number.