Subscriber Number

YPI1931848

Coverage Dates

1/1/23-12/31/24

Group

9184488

Plan

UnitedHealthcare (HEC30)

Name

Alex Wan

Relationship to the Insured

Self

Gender

Male

Date of Birth (DD/MM/YYYY)

1/10/2004

Employer

N/A

Phone

(555) 555-0193

Address

1528 Broadway, Times Square, Times Sq, New York, NY 10036

CPT

All

Number

9484322

Verified

1/9/23

Copay

$30

Deductible

$2,000.00

Pays At

80%