telephone icon330-264-9491 3205 Shreve Road, Wooster, OH 44691

Health Insurance Forms and Information

NOTICE OF PRIVACY PRACTICES


BENEFIT BOOKLETS

Health & Dental

TEA - passcode: tri100

HDHP - passcode:  hdhp

Dental

 


 MMOH - My Health Plan Login 

to print temporary insurance cards and monitor deductibles/copays.


Customer Service:  (800) 332-0741

24/7 Nurse Line:      (888) 912-0636

Dental:                      (866) 336-8251 

 

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

 


Visit Caremark.com to create an online account for easy refills, account information, forms, and much more.

Customer Care:  1-800-334-8134

Paper Claims:     CVS Caremark Claims Dept., PO Box 52136, Phoenix, AZ 85072-2136

 


 Creditable Coverage Notice


Affordable Health Care - Exchange Notice