Patient
Re-enrollment
Please enter the following information.
Last 4 digits of the 16 digit card number
Member ID
IMPORTANT UPDATE:
For 2022, we are implementing an automatic re-enrollment process which will automatically extend any patient with activity in 2021 through 2022. This means there is no action required to re-enroll a patient at this time. Patients may continue to utilize their copay benefits and you may submit explanation of benefits (EOBs) as normal.