E-NEWSLETTER SIGNUP

Health Insurance Forms and Information

NOTICE OF PRIVACY PRACTICES


 MMOH - My Health Plan Login 

to print temporary insurance cards and monitor deductibles/copays.


Customer Service:  (800) 382-5729

Billing Inquiries:  

Contact Sue Kruse (330) 264-9491


*** IMPORTANT ***

When adding or deleting coverage, please submit the changes to

Sue Kruse, Triway Treasurer 

Fax # 330-262-3955 or

Email  trwy_kruse@tccsa.net

Do NOT send enrollment or change forms to Medical Mutual.  Doing so will delay coverage.  Send to Sue Kruse.

 

Forms

Health Insurance Coverage Change Form  (this form MUST be returned to Sue Kruse, not Medical Mutual)
 

MMOH Claim Form
 

Adult Dependent Child Certification Form

 

Request to Extend Limiting Age for Dependent Child

 


Useful Links

Find a Provider - Medical Mutual web site

MMOH - My Health Plan Login

to set up your personal medical account

 


 

 

Prescription Information

Participating Pharmacies

www.CareMark.com

to set up your personal Rx account

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RXGrp: RX6670

BIN: 004336

PCN: ADV

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Customer Service:  (877) 673-3688

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Claim Form - Drug Reimbursement

Temporary Card - in case there are problems with the employee's personal account card.


 Creditable Coverage Notice


Affordable Health Care - Exchange Notice

3205 Shreve Road • Wooster, OH 44691 • 330.264.9491