Todays date:
12/08/2023
Guest membership effective date will be the 15th day following receipt of a completed
form. (Retroactive effective dates are not allowed.) Guest membership termination date will be six
months or one year following the effective start date. (Refer to selected category under Guest
Membership Details below. Termination dates can be sooner per member request based on need. Once
enrolled, you will receive a Guest Membership ID card and program materials regarding your Primary Care
Physician selection from the Host carrier based on the guest member’s address. If the subscriber’s
HMO/POS coverage is cancelled at any time, the Guest membership coverage will be cancelled.