2006-2007
Identification Card
Nationwide Life
Insurance Company
 
(Name of Scholar)
If premium has been paid, the Scholar whose name appears above has been insured under a policy issued to:
University of Florida
Group Policy Number
302-009-0904
Effective dates __/__/__ to __/__/__
Dependents: Spouse
Children
 
(Name of Spouse if applicable)
Claims Instruction Claims must be submitted to the Company within 90 days after date of treatment. Claim forms may be obtained from the Student Health Care Center or Fringe Benefit Coordinators, Inc., 1239 NW 10thAvenue, Gainesville, FL 32601. Telephone (800) 654-1452 or (352) 377-1239.Important to Medical Providers This plan incorporates a cost containment program that requires preadmission certification of all non-emergency admissions, and notification within 1 working day of all emergency admissions. Pre-certification is not a guarantee that benefits will be paid. For informa-tion or notification, call (800) 367-5826 or (352) 377-1239.