Request ID: 22	Status: COMPLETE
Request Date: 2018-11-29	Status Date: 2018-11-29
Member Name: Delaney Coman	Date of Birth: 1993-08-30
Employer ID: EAGL	Member ID: 12345678901
Effective Date: 2018-11-05	SSN: 258872885
Gender: F	Submitted By: 234230
Mailing Address: 972 Line Circle Decatur GA 30033	Home Address: 972 Line Circle Decatur GA 30033
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 24	Status: COMPLETE
Request Date: 2018-11-29	Status Date: 2018-11-29
Member Name: Gustavo Aramayo	Date of Birth: 1982-05-12
Employer ID: YETI	Member ID: 12345678901
Effective Date: 2018-12-01	SSN: 413410750
Gender: M	Submitted By: 94202
Mailing Address: 8510 Lamar Drive Arvada CO 80003	Home Address: 8510 Lamar Drive Arvada CO 80003
Phone Number:	Email Address:
Selected Plan: PL5255	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 33	Status: COMPLETE
Request Date: 2018-11-29	Status Date: 2018-11-29
Member Name: Ralph Goolsby	Date of Birth: 1989-11-09
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2018-12-01	SSN: 321849313
Gender: M	Submitted By: 120043
Mailing Address: 8610 S Maryland Pkwy Apt #2004 Las Vegas NV 89123
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 34	Status: COMPLETE
Request Date: 2018-11-29	Status Date: 2018-11-29
Member Name: Destiny Billiter	Date of Birth: 1996-01-01
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2018-12-01	SSN: 405495134
Gender: F	Submitted By: 120043
Mailing Address: 2210 ARCH DRIVE DANDRIDGE TN 37725
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 50	Status: COMPLETE
Request Date: 2018-11-30	Status Date: 2018-11-30
Member Name: Hao Dai	Date of Birth: 1990-03-06
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2018-11-01	SSN: 022118280
Gender: M	Submitted By: 120043
Mailing Address: 17800 Colima Rd. Rowland Heights CA 91748
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 221	Status: COMPLETE
Request Date: 2018-12-07	Status Date: 2018-12-07
Member Name: Raymond Edouard	Date of Birth: 1984-09-12
Employer ID: EAGL	Member ID: 12345678901
Effective Date: 2018-11-26	SSN: 208788265
Gender: M	Submitted By: 234230
Mailing Address: 1345 Hardeman Ave Apt 426 Macon GA 31201	Home Address: 1345 Hardeman Ave Apt 426 Macon GA 31201
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 222	Status: COMPLETE
Request Date: 2018-12-07	Status Date: 2018-12-07
Member Name: Ashley Corley	Date of Birth: 1983-01-18
Employer ID: EAGL	Member ID: 12345678901
Effective Date: 2018-11-01	SSN: 259672959
Gender: F	Submitted By: 234230
Mailing Address: 167 Stroud Rd McDonough GA 30252	Home Address: 167 Stroud Rd McDonough GA 30252
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 223	Status: COMPLETE
Request Date: 2018-12-07	Status Date: 2018-12-07
Member Name: Jasmine C Elston	Date of Birth: 1993-04-02
Employer ID: EAGL	Member ID: 12345678901
Effective Date: 2018-12-01	SSN: 252875257
Gender: F	Submitted By: 234230
Mailing Address: 506 Waterford Landing McDonough GA 30253	Home Address: 506 Waterford Landing McDonough GA 30253
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 223	Status: COMPLETE
Request Date: 2018-12-07	Status Date: 2018-12-07
Member Name: Hendrix Williams	Date of Birth: 2015-09-15
Employer ID: EAGL	Member ID: 12345678902
Effective Date: 2018-12-01	SSN: 502731051
Gender: M	Submitted By: 234230
Mailing Address: 506 Waterford Landing McDonough GA 30253
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 243	Status: COMPLETE
Request Date: 2018-12-10	Status Date: 2018-12-10
Member Name: Avery Huynh	Date of Birth: 2018-08-07
Employer ID: EAGL	Member ID: 12345678904
Effective Date: 2018-12-10	SSN: 632337300
Gender: F	Submitted By: 234230
Mailing Address: 4202 Creekrun Circle Buford GA 30519
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 243	Status: COMPLETE
Request Date: 2018-12-10	Status Date: 2018-12-10
Member Name: Thuy-An Nguyen	Date of Birth: 1986-02-19
Employer ID: EAGL	Member ID: 12345678901
Effective Date: 2018-12-10	SSN: 629665341
Gender: F	Submitted By: 234230
Mailing Address: 4202 Creekrun Cricle Buford GA 30519	Home Address: 4202 Creekrun Circle Buford GA 30519
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 243	Status: COMPLETE
Request Date: 2018-12-10	Status Date: 2018-12-10
Member Name: Phue Huynh	Date of Birth: 1985-04-30
Employer ID: EAGL	Member ID: 12345678902
Effective Date: 2018-12-10	SSN: 079861954
Gender: M	Submitted By: 234230
Mailing Address: 4202 Creekrun Circle Buford GA 30519
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 243	Status: COMPLETE
Request Date: 2018-12-10	Status Date: 2018-12-10
Member Name: Ayla Huynh	Date of Birth: 2015-10-18
Employer ID: EAGL	Member ID: 12345678903
Effective Date: 2018-12-10	SSN: 760787630
Gender: F	Submitted By: 234230
Mailing Address: 4202 Creekrun Circle Buford GA 30519
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 493	Status: COMPLETE
Request Date: 2018-12-26	Status Date: 2018-12-26
Member Name: Michael Hannah	Date of Birth: 1992-02-10
Employer ID: LAKEDISC	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 317118167
Gender: M	Submitted By: 289163
Mailing Address: 3271 124th Lane NE Unit B Blaine MN 55449	Home Address: 3271 124th Lane NE Unit B Blaine MN 55449
Phone Number: 3175174914	Email Address:
Selected Plan: PP3470	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 506	Status: COMPLETE
Request Date: 2018-12-26	Status Date: 2018-12-26
Member Name: Anthony Von Myers	Date of Birth: 1962-12-11
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 087640978
Gender: M	Submitted By: 205201
Mailing Address: 400 W St Elmo Rd Apt #117 Austin TX 78745	Home Address: 400 W St Elmo Rd Apt #117 Austin TX 78745
Phone Number: 9173409033	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 507	Status: COMPLETE
Request Date: 2018-12-26	Status Date: 2018-12-26
Member Name: Luca Randi	Date of Birth: 1973-09-29
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 616921786
Gender: M	Submitted By: 205201
Mailing Address: 1525 Grand ave San Diego CA 92109	Home Address: 1525 Grand ave San Diego CA 92109
Phone Number: 7606725822	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 543	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: George Swarez	Date of Birth: 1978-01-17
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 564991102
Gender: U	Submitted By: 205201
Mailing Address: 205 Fig Ave Chula Vista CA 91910	Home Address: 205 Fig Ave Chula Vista CA 91910
Phone Number: 6193964775	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 543	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: Julian Swarez	Date of Birth: 2001-05-28
Employer ID: WIRE	Member ID: 12345678902
Effective Date: 2019-01-01	SSN: 626258591
Gender: M	Submitted By: 205201
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 548	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: brent mckinney	Date of Birth: 1979-12-04
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2018-11-01	SSN: 645032863
Gender: M	Submitted By: 120043
Mailing Address: 14210 Brunswick Pl Dr Houston TX 77047
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 549	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: ELIAZAR RAMIREZ	Date of Birth: 1987-03-30
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2018-10-01	SSN: 602033894
Gender: F	Submitted By: 120043
Mailing Address: 1215 Bittern St. SAN DIEGO CA 92214
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 550	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: Enrico Fernandez	Date of Birth: 1977-09-07
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 301822750
Gender: M	Submitted By: 120043
Mailing Address: 30 Silverado Irvine CA 92618
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 550	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: Anjelica Fermandez	Date of Birth: 1984-06-15
Employer ID: WIRE	Member ID: 12345678902
Effective Date: 2019-01-01	SSN: 614186786
Gender: F	Submitted By: 120043
Mailing Address: 30 Silverado irvine CA 92618
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 550	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: Elijah Fernandez	Date of Birth: 1984-06-15
Employer ID: WIRE	Member ID: 12345678903
Effective Date: 2019-01-01	SSN: 007537007
Gender: M	Submitted By: 120043
Mailing Address: 30 Silverado irvine CA 92618
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 550	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: sylar fernandez	Date of Birth: 2017-01-21
Employer ID: WIRE	Member ID: 12345678904
Effective Date: 2019-01-01	SSN: 831581480
Gender: F	Submitted By: 120043
Mailing Address: 30 Silverado irvine CA 92618
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 551	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: ABEL TORRES	Date of Birth: 1975-09-06
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 619122484
Gender: M	Submitted By: 120043
Mailing Address: 4945 W 118th Pl Apt #17 Hawthorne 90250
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 551	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: GISELLE TORRES	Date of Birth: 2005-06-16
Employer ID: WIRE	Member ID: 12345678902
Effective Date: 2019-01-01	SSN: 620519365
Gender: F	Submitted By: 120043
Mailing Address: 4945 W 118th Pl Apt #17 Hawthorne CA 90250
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 552	Status: COMPLETE
Request Date: 2018-12-28	Status Date: 2018-12-28
Member Name: DARREN GOLDBERG	Date of Birth: 1969-12-22
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 549378727
Gender: M	Submitted By: 120043
Mailing Address: 10623 Pointe Mountain Top Cir Spring Valley CA 91978
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 568	Status: COMPLETE
Request Date: 2018-12-31	Status Date: 2018-12-31
Member Name: ERICK BERRIOS	Date of Birth: 1996-10-01
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 618947563
Gender: M	Submitted By: 120043
Mailing Address: 6550 4th Ave LOS ANGELES CA 90043
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 725	Status: COMPLETE
Request Date: 2019-01-03	Status Date: 2019-01-03
Member Name: MD Abu Taher Siddique	Date of Birth: 1958-10-03
Employer ID: ALLSTAFF	Member ID: 12345678901
Effective Date: 2019-01-01	SSN: 811613235
Gender: M	Submitted By: 265519
Mailing Address: 44249 Pentwater Clinton Township MI 48038	Home Address: 44249 Pentwater Clinton Township MI 48038
Phone Number:	Email Address:
Selected Plan: MCS444	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 725	Status: COMPLETE
Request Date: 2019-01-03	Status Date: 2019-01-03
Member Name: Anuwarea Begum	Date of Birth: 1966-06-12
Employer ID: ALLSTAFF	Member ID: 12345678902
Effective Date: 2019-01-01	SSN: 023316320
Gender: F	Submitted By: 265519
Mailing Address: 44249 Pentwater Clinton Township MI 48038
Phone Number:	Email Address:
Selected Plan: MCS444	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1113	Status: COMPLETE
Request Date: 2019-01-18	Status Date: 2019-01-18
Member Name: Emily Rodriguez	Date of Birth: 1971-06-26
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-02-01	SSN:
Gender: U	Submitted By: 335450
Mailing Address: 1708 Tuson Drive Wichita Falls TX
Phone Number: 4692636582	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1113	Status: COMPLETE
Request Date: 2019-01-18	Status Date: 2019-01-18
Member Name: Victoria Velasquez	Date of Birth: 2002-09-27
Employer ID: CNT	Member ID: 12345678902
Effective Date: 2019-02-01	SSN: 627845353
Gender: F	Submitted By: 335450
Mailing Address: 1708 Tucson Rd. Wichita Falls TX 76306
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1125	Status: COMPLETE
Request Date: 2019-01-18	Status Date: 2019-01-18
Member Name: Steve Vaughan	Date of Birth: 1958-09-11
Employer ID: VAUGHAN	Member ID: 94259284901
Effective Date: 2019-01-01	SSN: 535601087
Gender: M	Submitted By: 332291
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1125	Status: COMPLETE
Request Date: 2019-01-18	Status Date: 2019-01-18
Member Name: Shannon Vaughan	Date of Birth: 1971-03-15
Employer ID: VAUGHAN	Member ID: 94259284902
Effective Date: 2019-01-01	SSN: 535114366
Gender: F	Submitted By: 332291
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1301	Status: COMPLETE
Request Date: 2019-01-25	Status Date: 2019-01-25
Member Name: Hannah Callahan	Date of Birth: 1992-11-16
Employer ID: EAGL	Member ID: 59527821701
Effective Date: 2019-01-01	SSN: 595278217
Gender: F	Submitted By: 234230
Mailing Address: 102 Sawleaf Lane Peachtree City GA 30269	Home Address: 102 Sawleaf Lane Peachtree City GA 30269
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1967	Status: COMPLETE
Request Date: 2019-02-08	Status Date: 2019-02-08
Member Name: Rodney Henry	Date of Birth: 1966-09-17
Employer ID: SHASTA	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 565735849
Gender: M	Submitted By: 348872
Mailing Address: 9562 E Gary St Mesa AZ 85207	Home Address: 9562 E Gary St Mesa AZ 85207
Phone Number: 4807106415	Email Address:
Selected Plan: ZCP007	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1967	Status: COMPLETE
Request Date: 2019-02-08	Status Date: 2019-02-08
Member Name: Charlotte Henry	Date of Birth: 1968-06-27
Employer ID: SHASTA	Member ID: 12345678902
Effective Date: 2019-02-01	SSN: 561354936
Gender: F	Submitted By: 348872
Mailing Address: 9562 E Gary St Mesa AZ 85207
Phone Number:	Email Address:
Selected Plan: ZCP007	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1981	Status: COMPLETE
Request Date: 2016-06-09	Status Date: 2016-06-09
Member Name: FAWN KELLY	Date of Birth: 1980-08-15
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN: 537867931
Gender: F	Submitted By: 56054
Mailing Address: 1402 W CORA COURT SPOKANE WA 99205
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1981	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: FAWN KELLY	Date of Birth: 1980-08-15
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 537867931
Gender: F	Submitted By: 294404
Mailing Address: 1402 W CORA COURT SPOKANE WA 99205
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1982	Status: COMPLETE
Request Date: 2016-06-09	Status Date: 2016-06-09
Member Name: CHRISTOPHER HODEL	Date of Birth: 1993-06-16
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN: 523897403
Gender: M	Submitted By: 56054
Mailing Address: 2136 W RIVERSIDE AVE SPOKANE WA 99201
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1983	Status: COMPLETE
Request Date: 2016-06-09	Status Date: 2016-06-09
Member Name: CHRISTOPHER LANFRI	Date of Birth: 1990-01-02
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN: 542351745
Gender: M	Submitted By: 56054
Mailing Address: 612 S LINCOLN ST APT 313 SPOKANE WA 99204
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1984	Status: COMPLETE
Request Date: 2016-06-09	Status Date: 2016-06-09
Member Name: AMY BURRIL	Date of Birth: 1982-09-27
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN: 537900660
Gender: F	Submitted By: 56054
Mailing Address: 13610 N DOVER ROAD NINE MILE FALLS WA 99026
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 1985	Status: COMPLETE
Request Date: 2016-06-09	Status Date: 2016-06-09
Member Name: JEAN CROOK	Date of Birth: 1957-08-04
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN: 533685925
Gender: F	Submitted By: 56054
Mailing Address: 823 E GARLAND SPOKANE WA 99207
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2021	Status: COMPLETE
Request Date: 2016-06-12	Status Date: 2016-06-12
Member Name: brandon johnson	Date of Birth: 1984-12-19
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN: 532986958
Gender: M	Submitted By: 56054
Mailing Address: 812 brentwood spokane WA 99217
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments: //what effective date would you like to use?

Request ID: 2021	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: brandon johnson	Date of Birth: 1984-12-19
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 532986958
Gender: M	Submitted By: 294404
Mailing Address: 812 brentwood spokane WA 99217
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments: //what effective date would you like to use?

Request ID: 2021	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: brandon johnson	Date of Birth: 1984-12-19
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 532986958
Gender: M	Submitted By: 294404
Mailing Address: 812 brentwood spokane WA 99217
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2021	Status: COMPLETE
Request Date: 2016-06-12	Status Date: 2016-06-12
Member Name: brandon johnson	Date of Birth: 1984-12-19
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN: 532986958
Gender: M	Submitted By: 56054
Mailing Address: 812 brentwood spokane WA 99217
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2022	Status: COMPLETE
Request Date: 2016-06-12	Status Date: 2016-06-12
Member Name: sara bowen	Date of Birth: 1982-12-06
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN:
Gender: F	Submitted By: 56054
Mailing Address: 5416 W Matts Lane Spokane WA 99224
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2022	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: sara bowen	Date of Birth: 1982-12-06
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN:
Gender: F	Submitted By: 294404
Mailing Address: 5416 W Matts Lane Spokane WA 99224
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2022	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: sara bowen	Date of Birth: 1982-12-06
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN:
Gender: F	Submitted By: 294404
Mailing Address: 5416 W Matts Lane Spokane WA 99224
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 2022	Status: COMPLETE
Request Date: 2016-06-12	Status Date: 2016-06-12
Member Name: sara bowen	Date of Birth: 1982-12-06
Employer ID: NTC	Member ID: 12345678901
Effective Date: null	SSN:
Gender: F	Submitted By: 56054
Mailing Address: 5416 W Matts Lane Spokane WA 99224
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 2022	Status: COMPLETE
Request Date: 2016-06-12	Status Date: 2016-06-12
Member Name: null null null	Date of Birth: null
Employer ID: NTC	Member ID: 89792751001
Effective Date: null	SSN: null
Gender: U	Submitted By: 56054
Mailing Address: 604 MEADOWBEND RD WILLISTON VT 05495
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2022	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 89792751001
Effective Date: null	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 604 MEADOWBEND RD WILLISTON VT 05495
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2022	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 89792751001
Effective Date: null	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 604 MEADOWBEND RD WILLISTON VT 05495
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 2022	Status: COMPLETE
Request Date: 2016-06-12	Status Date: 2016-06-12
Member Name: null null null	Date of Birth: null
Employer ID: NTC	Member ID: 89792751001
Effective Date: null	SSN: null
Gender: U	Submitted By: 56054
Mailing Address: 604 MEADOWBEND RD WILLISTON VT 05495
Phone Number:	Email Address:
Selected Plan: MCS169	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 2050	Status: COMPLETE
Request Date: 2016-06-13	Status Date: 2016-06-13
Member Name: Nancy Howell	Date of Birth: 1963-04-15
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 401063771
Gender: F	Submitted By: 57087
Mailing Address: 4 Four Sixes Circle Wichita Falls TX 76308
Phone Number: 9407811015	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Nancy Howell	Date of Birth: 1963-04-15
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 401063771
Gender: F	Submitted By: 335450
Mailing Address: 4 Four Sixes Circle Wichita Falls TX 76308
Phone Number: 9407811015	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Nancy Howell	Date of Birth: 1963-04-15
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 401063771
Gender: F	Submitted By: 335450
Mailing Address: 4 Four Sixes Circle Wichita Falls TX 76308
Phone Number: 9407811015	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2016-06-13	Status Date: 2016-06-13
Member Name: Nancy Howell	Date of Birth: 1963-04-15
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 401063771
Gender: F	Submitted By: 57087
Mailing Address: 4 Four Sixes Circle Wichita Falls TX 76308
Phone Number: 9407811015	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2016-06-13	Status Date: 2016-06-13
Member Name: Andrew Howell	Date of Birth: 2001-12-26
Employer ID: null	Member ID: 12345678902
Effective Date: 2019-02-01	SSN: 628809282
Gender: M	Submitted By: 57087
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Andrew Howell	Date of Birth: 2001-12-26
Employer ID: CNT	Member ID: 12345678902
Effective Date: 2019-02-01	SSN: 628809282
Gender: M	Submitted By: 335450
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Andrew Howell	Date of Birth: 2001-12-26
Employer ID: CNT	Member ID: 12345678902
Effective Date: 2019-02-01	SSN: 628809282
Gender: M	Submitted By: 335450
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2016-06-13	Status Date: 2016-06-13
Member Name: Andrew Howell	Date of Birth: 2001-12-26
Employer ID: null	Member ID: 12345678902
Effective Date: 2019-02-01	SSN: 628809282
Gender: M	Submitted By: 57087
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2016-06-13	Status Date: 2016-06-13
Member Name: Benjamin Howell	Date of Birth: 2003-06-24
Employer ID: null	Member ID: 12345678903
Effective Date: 2019-02-01	SSN: 642869926
Gender: M	Submitted By: 57087
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Benjamin Howell	Date of Birth: 2003-06-24
Employer ID: CNT	Member ID: 12345678903
Effective Date: 2019-02-01	SSN: 642869926
Gender: M	Submitted By: 335450
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Benjamin Howell	Date of Birth: 2003-06-24
Employer ID: CNT	Member ID: 12345678903
Effective Date: 2019-02-01	SSN: 642869926
Gender: M	Submitted By: 335450
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2050	Status: COMPLETE
Request Date: 2016-06-13	Status Date: 2016-06-13
Member Name: Benjamin Howell	Date of Birth: 2003-06-24
Employer ID: null	Member ID: 12345678903
Effective Date: 2019-02-01	SSN: 642869926
Gender: M	Submitted By: 57087
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2062	Status: COMPLETE
Request Date: 2016-06-13	Status Date: 2016-06-13
Member Name: Leah Dewey	Date of Birth: 1986-05-20
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613363996
Gender: F	Submitted By: 57087
Mailing Address: 2650 North Villa Real Drive Orange CA 92867	Home Address: 2650 North Villa Real Drive Orange CA 92867
Phone Number: 8059071311	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2062	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Leah Dewey	Date of Birth: 1986-05-20
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613363996
Gender: F	Submitted By: 333976
Mailing Address: 2650 North Villa Real Drive Orange CA 92867	Home Address: 2650 North Villa Real Drive Orange CA 92867
Phone Number: 8059071311	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2062	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Leah Dewey	Date of Birth: 1986-05-20
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613363996
Gender: F	Submitted By: 333976
Mailing Address: 2650 North Villa Real Drive Orange CA 92867	Home Address: 2650 North Villa Real Drive Orange CA 92867
Phone Number: 8059071311	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2062	Status: COMPLETE
Request Date: 2016-06-13	Status Date: 2016-06-13
Member Name: Leah Dewey	Date of Birth: 1986-05-20
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613363996
Gender: F	Submitted By: 57087
Mailing Address: 2650 North Villa Real Drive Orange CA 92867	Home Address: 2650 North Villa Real Drive Orange CA 92867
Phone Number: 8059071311	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2075	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Kathryn Brandon	Date of Birth: 1994-05-04
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 609768079
Gender: F	Submitted By: 333976
Mailing Address: 650 E Capitol Ave #140 Milpitas CA 95035	Home Address: 650 E Capitol Ave #140 Milpitas CA 95035
Phone Number: 4084661930	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2077	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Carolina Nimmer	Date of Birth: 1967-05-11
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 546670225
Gender: F	Submitted By: 333976
Mailing Address: 2100 Pacheco Street Apt 411 Concord CA 94520	Home Address: 2100 Pacheco Street Apt 411 Concord CA 94520
Phone Number: 9254574493	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2078	Status: COMPLETE
Request Date: 2019-02-11	Status Date: 2019-02-11
Member Name: Natalia Gottlieb	Date of Birth: 1971-02-01
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 621272131
Gender: F	Submitted By: 333976
Mailing Address: 22035 Burbank Blvd # 120 Woodland Hills CA 91367	Home Address: 22035 Burbank Blvd # 120 Woodland Hills CO 91367
Phone Number: 8185232964	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2147	Status: COMPLETE
Request Date: 2016-06-22	Status Date: 2016-06-22
Member Name: Oscar Beltran	Date of Birth: 1991-10-14
Employer ID: TTC	Member ID: 12345678901
Effective Date: null	SSN: 627283636
Gender: M	Submitted By: 55914
Mailing Address: 5263 Lady Slipper Ct. Colorado Springs CO 80922	Home Address: 5263 Lady Slipper Ct. Colorado Springs CO 80922
Phone Number: 7193108482	Email Address:
Selected Plan: MCS165	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//06/01/2016

Request ID: 2147	Status: COMPLETE
Request Date: 2019-02-12	Status Date: 2019-02-12
Member Name: Oscar Beltran	Date of Birth: 1991-10-14
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 627283636
Gender: M	Submitted By: 308152
Mailing Address: 5263 Lady Slipper Ct. Colorado Springs CO 80922	Home Address: 5263 Lady Slipper Ct. Colorado Springs CO 80922
Phone Number: 7193108482	Email Address:
Selected Plan: MCS165	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//06/01/2016

Request ID: 2147	Status: COMPLETE
Request Date: 2019-02-12	Status Date: 2019-02-12
Member Name: Oscar Beltran	Date of Birth: 1991-10-14
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 627283636
Gender: M	Submitted By: 308152
Mailing Address: 5263 Lady Slipper Ct. Colorado Springs CO 80922	Home Address: 5263 Lady Slipper Ct. Colorado Springs CO 80922
Phone Number: 7193108482	Email Address:
Selected Plan: MCS165	Medical: Yes Vision: No Dental: No
Comments: Member never got cards, updated address, submitted eligibility request for new address update

Request ID: 2147	Status: COMPLETE
Request Date: 2016-06-22	Status Date: 2016-06-22
Member Name: Oscar Beltran	Date of Birth: 1991-10-14
Employer ID: TTC	Member ID: 12345678901
Effective Date: null	SSN: 627283636
Gender: M	Submitted By: 55914
Mailing Address: 5263 Lady Slipper Ct. Colorado Springs CO 80922	Home Address: 5263 Lady Slipper Ct. Colorado Springs CO 80922
Phone Number: 7193108482	Email Address:
Selected Plan: MCS165	Medical: Yes Vision: No Dental: No
Comments: Member never got cards, updated address, submitted eligibility request for new address update

Request ID: 2201	Status: COMPLETE
Request Date: 2016-07-13	Status Date: 2016-07-13
Member Name: test test test	Date of Birth: 2019-02-01
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 123456789
Gender: M	Submitted By: 58902
Mailing Address: test test test AZ 85044	Home Address: test test test AZ 85044
Phone Number: 4805556677	Email Address:
Selected Plan: 710000	Medical: Yes Vision: Yes V1 Dental: Yes D1
Comments:

Request ID: 2201	Status: COMPLETE
Request Date: 2019-02-13	Status Date: 2019-02-13
Member Name: test test test	Date of Birth: 2019-02-01
Employer ID: NNEBP	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test test AZ 85044	Home Address: test test test AZ 85044
Phone Number: 4805556677	Email Address:
Selected Plan: 710000	Medical: Yes Vision: Yes V1 Dental: Yes D1
Comments:

Request ID: 2201	Status: COMPLETE
Request Date: 2019-02-13	Status Date: 2019-02-13
Member Name: test test test	Date of Birth: 2019-02-01
Employer ID: NNEBP	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test test AZ 85044	Home Address: test test test AZ 85044
Phone Number: 4805556677	Email Address:
Selected Plan: 710000	Medical: Yes Vision: Yes V1 Dental: Yes D1
Comments:

Request ID: 2201	Status: COMPLETE
Request Date: 2016-07-13	Status Date: 2016-07-13
Member Name: test test test	Date of Birth: 2019-02-01
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 123456789
Gender: M	Submitted By: 58902
Mailing Address: test test test AZ 85044	Home Address: test test test AZ 85044
Phone Number: 4805556677	Email Address:
Selected Plan: 710000	Medical: Yes Vision: Yes V1 Dental: Yes D1
Comments:

Request ID: 2409	Status: COMPLETE
Request Date: 2019-02-15	Status Date: 2019-02-15
Member Name: Sean McNealley	Date of Birth: 1992-05-03
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 536270170
Gender: M	Submitted By: 332291
Mailing Address: PO Box 1116 McCleary WA 98557
Phone Number: 3605803968	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2411	Status: COMPLETE
Request Date: 2019-02-15	Status Date: 2019-02-15
Member Name: Bradley Nolan	Date of Birth: 1984-04-04
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 535989896
Gender: M	Submitted By: 332291
Mailing Address: PO Box 1847 Elma WA 98541
Phone Number: 608786664	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2571	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Gwendolyn Hampton	Date of Birth: 1983-12-26
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 449677787
Gender: F	Submitted By: 335450
Mailing Address: 1042 Westerly Pl. Wichita Falls TX 76309
Phone Number: 9407308282	Email Address:
Selected Plan: CTH100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2582	Status: COMPLETE
Request Date: 2016-07-19	Status Date: 2016-07-19
Member Name: Cynthia Howery	Date of Birth: 1983-09-21
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 452653795
Gender: F	Submitted By: 62281
Mailing Address: 504 Kemp Blvd. Wichita Falls TX 76301
Phone Number: 9407339790	Email Address:
Selected Plan: CTH100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2582	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Cynthia Howery	Date of Birth: 1983-09-21
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 452653795
Gender: F	Submitted By: 335450
Mailing Address: 504 Kemp Blvd. Wichita Falls TX 76301
Phone Number: 9407339790	Email Address:
Selected Plan: CTH100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2582	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Cynthia Howery	Date of Birth: 1983-09-21
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 452653795
Gender: F	Submitted By: 335450
Mailing Address: 504 Kemp Blvd. Wichita Falls TX 76301
Phone Number: 9407339790	Email Address:
Selected Plan: CTH100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2582	Status: COMPLETE
Request Date: 2016-07-19	Status Date: 2016-07-19
Member Name: Cynthia Howery	Date of Birth: 1983-09-21
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 452653795
Gender: F	Submitted By: 62281
Mailing Address: 504 Kemp Blvd. Wichita Falls TX 76301
Phone Number: 9407339790	Email Address:
Selected Plan: CTH100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2589	Status: COMPLETE
Request Date: 2016-07-19	Status Date: 2016-07-19
Member Name: Christian Contreras	Date of Birth: 1996-08-05
Employer ID: TRAVIS	Member ID: 12345678901
Effective Date: null	SSN: 609921626
Gender: M	Submitted By: 62307
Mailing Address: 10942 Merino St Apple Valley CA 92308	Home Address: 10942 Merino St Apple Valley CA 92308
Phone Number:	Email Address:
Selected Plan: EP2181	Medical: Yes Vision: No Dental: No
Comments: //what effective date should I use. the status date says same date as request date?//effective date: 8/1/16

Request ID: 2589	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Christian Contreras	Date of Birth: 1996-08-05
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 609921626
Gender: M	Submitted By: 276683
Mailing Address: 10942 Merino St Apple Valley CA 92308	Home Address: 10942 Merino St Apple Valley CA 92308
Phone Number:	Email Address:
Selected Plan: EP2181	Medical: Yes Vision: No Dental: No
Comments: //what effective date should I use. the status date says same date as request date?//effective date: 8/1/16

Request ID: 2605	Status: COMPLETE
Request Date: 2016-07-20	Status Date: 2016-07-20
Member Name: Pedro I Jimenez	Date of Birth: 1974-06-30
Employer ID: BSR	Member ID: 150301
Effective Date: null	SSN: 532410894
Gender: M	Submitted By: 58902
Mailing Address: 4511 Track Road Wapato WA 98951	Home Address: 4511 Track Road Wapato WA 98951
Phone Number: 5094068442	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//

Request ID: 2605	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Pedro I Jimenez	Date of Birth: 1974-06-30
Employer ID: null	Member ID: 150301
Effective Date: null	SSN: 532410894
Gender: M	Submitted By: 294404
Mailing Address: 4511 Track Road Wapato WA 98951	Home Address: 4511 Track Road Wapato WA 98951
Phone Number: 5094068442	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//

Request ID: 2605	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Pedro I Jimenez	Date of Birth: 1974-06-30
Employer ID: null	Member ID: 150301
Effective Date: null	SSN: 532410894
Gender: M	Submitted By: 294404
Mailing Address: 4511 Track Road Wapato WA 98951	Home Address: 4511 Track Road Wapato WA 98951
Phone Number: 5094068442	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2605	Status: COMPLETE
Request Date: 2016-07-20	Status Date: 2016-07-20
Member Name: Pedro I Jimenez	Date of Birth: 1974-06-30
Employer ID: BSR	Member ID: 150301
Effective Date: null	SSN: 532410894
Gender: M	Submitted By: 58902
Mailing Address: 4511 Track Road Wapato WA 98951	Home Address: 4511 Track Road Wapato WA 98951
Phone Number: 5094068442	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2608	Status: COMPLETE
Request Date: 2016-07-20	Status Date: 2016-07-20
Member Name: Eva Gallegos L.	Date of Birth: 1976-02-05
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 625876534
Gender: F	Submitted By: 58902
Mailing Address: P.O. Box 1167 Wapato WA 98951	Home Address: 708 S. Wasco Avenue Wapato WA 98951
Phone Number: 5099457683	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//

Request ID: 2608	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Eva Gallegos L.	Date of Birth: 1976-02-05
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 625876534
Gender: F	Submitted By: 294404
Mailing Address: P.O. Box 1167 Wapato WA 98951	Home Address: 708 S. Wasco Avenue Wapato WA 98951
Phone Number: 5099457683	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//

Request ID: 2608	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Eva Gallegos L.	Date of Birth: 1976-02-05
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 625876534
Gender: F	Submitted By: 294404
Mailing Address: P.O. Box 1167 Wapato WA 98951	Home Address: 708 S. Wasco Avenue Wapato WA 98951
Phone Number: 5099457683	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2608	Status: COMPLETE
Request Date: 2016-07-20	Status Date: 2016-07-20
Member Name: Eva Gallegos L.	Date of Birth: 1976-02-05
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 625876534
Gender: F	Submitted By: 58902
Mailing Address: P.O. Box 1167 Wapato WA 98951	Home Address: 708 S. Wasco Avenue Wapato WA 98951
Phone Number: 5099457683	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2609	Status: COMPLETE
Request Date: 2016-07-20	Status Date: 2016-07-20
Member Name: Cristina Garfais Ayala	Date of Birth: 1969-02-14
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 614538829
Gender: F	Submitted By: 58902
Mailing Address: 1841 Deeringhoff Road Moxee WA 98936	Home Address: 1841 Deeringhoff Road Moxee WA 98951
Phone Number: 5094800107	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//

Request ID: 2609	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Cristina Garfais Ayala	Date of Birth: 1969-02-14
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 614538829
Gender: F	Submitted By: 294404
Mailing Address: 1841 Deeringhoff Road Moxee WA 98936	Home Address: 1841 Deeringhoff Road Moxee WA 98951
Phone Number: 5094800107	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//

Request ID: 2609	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Cristina Garfais Ayala	Date of Birth: 1969-02-14
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 614538829
Gender: F	Submitted By: 294404
Mailing Address: 1841 Deeringhoff Road Moxee WA 98936	Home Address: 1841 Deeringhoff Road Moxee WA 98951
Phone Number: 5094800107	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2609	Status: COMPLETE
Request Date: 2016-07-20	Status Date: 2016-07-20
Member Name: Cristina Garfais Ayala	Date of Birth: 1969-02-14
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 614538829
Gender: F	Submitted By: 58902
Mailing Address: 1841 Deeringhoff Road Moxee WA 98936	Home Address: 1841 Deeringhoff Road Moxee WA 98951
Phone Number: 5094800107	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2615	Status: COMPLETE
Request Date: 2019-02-22	Status Date: 2019-02-22
Member Name: Jose R Pineda	Date of Birth: 1973-05-16
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 608148859
Gender: M	Submitted By: 333976
Mailing Address: 23118 Baltar St West Hills CA 91304	Home Address: 23118 Baltar St West Hills CA 91304
Phone Number: 8184624102	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2663	Status: COMPLETE
Request Date: 2016-07-21	Status Date: 2016-07-21
Member Name: Guadalupe J. Avial Arrollo	Date of Birth: 1968-04-25
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 531332939
Gender: M	Submitted By: 56524
Mailing Address: P.O. Box 1069 Wapato WA 98951	Home Address: 207 W. Elizabeth St. Wapato WA 98951
Phone Number: 5093795571	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//7/1/16

Request ID: 2663	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Guadalupe J. Avial Arrollo	Date of Birth: 1968-04-25
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 531332939
Gender: M	Submitted By: 294404
Mailing Address: P.O. Box 1069 Wapato WA 98951	Home Address: 207 W. Elizabeth St. Wapato WA 98951
Phone Number: 5093795571	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//7/1/16

Request ID: 2663	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Guadalupe J. Avial Arrollo	Date of Birth: 1968-04-25
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 531332939
Gender: M	Submitted By: 294404
Mailing Address: P.O. Box 1069 Wapato WA 98951	Home Address: 207 W. Elizabeth St. Wapato WA 98951
Phone Number: 5093795571	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2663	Status: COMPLETE
Request Date: 2016-07-21	Status Date: 2016-07-21
Member Name: Guadalupe J. Avial Arrollo	Date of Birth: 1968-04-25
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 531332939
Gender: M	Submitted By: 56524
Mailing Address: P.O. Box 1069 Wapato WA 98951	Home Address: 207 W. Elizabeth St. Wapato WA 98951
Phone Number: 5093795571	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2665	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Pedro Jimenez	Date of Birth: 1974-06-30
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 532410894
Gender: M	Submitted By: 294404
Mailing Address: 4511 Track Road Wapato WA 98951	Home Address: 4511 Track Road Wapato WA 98951
Phone Number: 5094068442	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2665	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Pedro Jimenez	Date of Birth: 1974-06-30
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 532410894
Gender: M	Submitted By: 294404
Mailing Address: 4511 Track Road Wapato WA 98951	Home Address: 4511 Track Road Wapato WA 98951
Phone Number: 5094068442	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//There is two for Pedro Jimenez we have the Confirmation #2665

Request ID: 2665	Status: COMPLETE
Request Date: 2016-07-21	Status Date: 2016-07-21
Member Name: Pedro Jimenez	Date of Birth: 1974-06-30
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 532410894
Gender: M	Submitted By: 58902
Mailing Address: 4511 Track Road Wapato WA 98951	Home Address: 4511 Track Road Wapato WA 98951
Phone Number: 5094068442	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //what effective date?//There is two for Pedro Jimenez we have the Confirmation #2665

Request ID: 2665	Status: COMPLETE
Request Date: 2016-07-21	Status Date: 2016-07-21
Member Name: Pedro Jimenez	Date of Birth: 1974-06-30
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 532410894
Gender: M	Submitted By: 58902
Mailing Address: 4511 Track Road Wapato WA 98951	Home Address: 4511 Track Road Wapato WA 98951
Phone Number: 5094068442	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2703	Status: COMPLETE
Request Date: 2016-07-22	Status Date: 2016-07-22
Member Name: Servando Santos-Galindo	Date of Birth: 1983-10-23
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 545998666
Gender: M	Submitted By: 56524
Mailing Address: 2415 S. 10th Avenue Union Gap WA 98903	Home Address: 2415 S. 10th Avenue Union Gap WA 98903
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //effective date?//8/1/16

Request ID: 2703	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Servando Santos-Galindo	Date of Birth: 1983-10-23
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 545998666
Gender: M	Submitted By: 294404
Mailing Address: 2415 S. 10th Avenue Union Gap WA 98903	Home Address: 2415 S. 10th Avenue Union Gap WA 98903
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //effective date?//8/1/16

Request ID: 2703	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Servando Santos-Galindo	Date of Birth: 1983-10-23
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 545998666
Gender: M	Submitted By: 294404
Mailing Address: 2415 S. 10th Avenue Union Gap WA 98903	Home Address: 2415 S. 10th Avenue Union Gap WA 98903
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2703	Status: COMPLETE
Request Date: 2016-07-22	Status Date: 2016-07-22
Member Name: Servando Santos-Galindo	Date of Birth: 1983-10-23
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 545998666
Gender: M	Submitted By: 56524
Mailing Address: 2415 S. 10th Avenue Union Gap WA 98903	Home Address: 2415 S. 10th Avenue Union Gap WA 98903
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2704	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Jorge Cardenas Soto	Date of Birth: 1987-04-22
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 562098741
Gender: M	Submitted By: 294404
Mailing Address: 1411 Willow Street Yakima WA 98902	Home Address: 1411 Willow Street Yakima WA 98902
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //effective date?//8/1/16

Request ID: 2704	Status: COMPLETE
Request Date: 2016-07-22	Status Date: 2016-07-22
Member Name: Jorge Cardenas Soto	Date of Birth: 1987-04-22
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 562098741
Gender: M	Submitted By: 56524
Mailing Address: 1411 Willow Street Yakima WA 98902	Home Address: 1411 Willow Street Yakima WA 98902
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //effective date?//8/1/16

Request ID: 2704	Status: COMPLETE
Request Date: 2016-07-22	Status Date: 2016-07-22
Member Name: Jorge Cardenas Soto	Date of Birth: 1987-04-22
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 562098741
Gender: M	Submitted By: 56524
Mailing Address: 1411 Willow Street Yakima WA 98902	Home Address: 1411 Willow Street Yakima WA 98902
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 2704	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Jorge Cardenas Soto	Date of Birth: 1987-04-22
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 562098741
Gender: M	Submitted By: 294404
Mailing Address: 1411 Willow Street Yakima WA 98902	Home Address: 1411 Willow Street Yakima WA 98902
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 2704	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 45587899501
Effective Date: null	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 643 CREEKSIDE LN FISHKILL NY 12524
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //effective date?//8/1/16

Request ID: 2704	Status: COMPLETE
Request Date: 2016-07-22	Status Date: 2016-07-22
Member Name: null null null	Date of Birth: null
Employer ID: BSR	Member ID: 45587899501
Effective Date: null	SSN: null
Gender: U	Submitted By: 56524
Mailing Address: 643 CREEKSIDE LN FISHKILL NY 12524
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //effective date?//8/1/16

Request ID: 2704	Status: COMPLETE
Request Date: 2016-07-22	Status Date: 2016-07-22
Member Name: null null null	Date of Birth: null
Employer ID: BSR	Member ID: 45587899501
Effective Date: null	SSN: null
Gender: U	Submitted By: 56524
Mailing Address: 643 CREEKSIDE LN FISHKILL NY 12524
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 2704	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 45587899501
Effective Date: null	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 643 CREEKSIDE LN FISHKILL NY 12524
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 2705	Status: COMPLETE
Request Date: 2016-07-22	Status Date: 2016-07-22
Member Name: Salvador Carmona-Ruiz	Date of Birth: 1979-07-19
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 629992038
Gender: M	Submitted By: 56524
Mailing Address: 1121 E. Viola Ave, Apt C-210 Yakima WA 98901	Home Address: 1121 E. Viola Ave, Apt C-210 Yakima WA 98901
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //effective date?//8/1/16

Request ID: 2705	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Salvador Carmona-Ruiz	Date of Birth: 1979-07-19
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 629992038
Gender: M	Submitted By: 294404
Mailing Address: 1121 E. Viola Ave, Apt C-210 Yakima WA 98901	Home Address: 1121 E. Viola Ave, Apt C-210 Yakima WA 98901
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: //effective date?//8/1/16

Request ID: 2705	Status: COMPLETE
Request Date: 2019-02-25	Status Date: 2019-02-25
Member Name: Salvador Carmona-Ruiz	Date of Birth: 1979-07-19
Employer ID: null	Member ID: 12345678901
Effective Date: null	SSN: 629992038
Gender: M	Submitted By: 294404
Mailing Address: 1121 E. Viola Ave, Apt C-210 Yakima WA 98901	Home Address: 1121 E. Viola Ave, Apt C-210 Yakima WA 98901
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2705	Status: COMPLETE
Request Date: 2016-07-22	Status Date: 2016-07-22
Member Name: Salvador Carmona-Ruiz	Date of Birth: 1979-07-19
Employer ID: BSR	Member ID: 12345678901
Effective Date: null	SSN: 629992038
Gender: M	Submitted By: 56524
Mailing Address: 1121 E. Viola Ave, Apt C-210 Yakima WA 98901	Home Address: 1121 E. Viola Ave, Apt C-210 Yakima WA 98901
Phone Number:	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2782	Status: COMPLETE
Request Date: 2016-07-25	Status Date: 2016-07-25
Member Name: test test	Date of Birth: 1922-02-02
Employer ID: CCI	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 123456789
Gender: M	Submitted By: 63504
Mailing Address: test test AZ 85044
Phone Number: 4805550683	Email Address: out.print(rs.getString(16));
Selected Plan: EP2108	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2782	Status: COMPLETE
Request Date: 2019-02-26	Status Date: 2019-02-26
Member Name: test test	Date of Birth: 1922-02-02
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 123456789
Gender: M	Submitted By: 294404
Mailing Address: test test AZ 85044
Phone Number: 4805550683	Email Address: out.print(rs.getString(16));
Selected Plan: EP2108	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2782	Status: COMPLETE
Request Date: 2019-02-26	Status Date: 2019-02-26
Member Name: test test	Date of Birth: 1922-02-02
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 123456789
Gender: M	Submitted By: 294404
Mailing Address: test test AZ 85044
Phone Number: 4805550683	Email Address: out.print(rs.getString(16));
Selected Plan: EP2108	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2782	Status: COMPLETE
Request Date: 2016-07-25	Status Date: 2016-07-25
Member Name: test test	Date of Birth: 1922-02-02
Employer ID: CCI	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 123456789
Gender: M	Submitted By: 63504
Mailing Address: test test AZ 85044
Phone Number: 4805550683	Email Address: out.print(rs.getString(16));
Selected Plan: EP2108	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2782	Status: COMPLETE
Request Date: 2016-07-25	Status Date: 2016-07-25
Member Name: null null null	Date of Birth: null
Employer ID: CCI	Member ID: 15605593501
Effective Date: 2016-08-01	SSN: null
Gender: U	Submitted By: 63504
Mailing Address: 4201 MASSACHUSETTS AVE NW APT 8251 WASHINGTON 20016
Phone Number:	Email Address:
Selected Plan: EP2108	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2782	Status: COMPLETE
Request Date: 2019-02-26	Status Date: 2019-02-26
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 15605593501
Effective Date: 2016-08-01	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 4201 MASSACHUSETTS AVE NW APT 8251 WASHINGTON 20016
Phone Number:	Email Address:
Selected Plan: EP2108	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2782	Status: COMPLETE
Request Date: 2019-02-26	Status Date: 2019-02-26
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 15605593501
Effective Date: 2016-08-01	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 4201 MASSACHUSETTS AVE NW APT 8251 WASHINGTON 20016
Phone Number:	Email Address:
Selected Plan: EP2108	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2782	Status: COMPLETE
Request Date: 2016-07-25	Status Date: 2016-07-25
Member Name: null null null	Date of Birth: null
Employer ID: CCI	Member ID: 15605593501
Effective Date: 2016-08-01	SSN: null
Gender: U	Submitted By: 63504
Mailing Address: 4201 MASSACHUSETTS AVE NW APT 8251 WASHINGTON 20016
Phone Number:	Email Address:
Selected Plan: EP2108	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2783	Status: COMPLETE
Request Date: 2016-07-26	Status Date: 2016-07-26
Member Name: Kassi Fugett	Date of Birth: 1979-01-17
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 462453976
Gender: F	Submitted By: 56174
Mailing Address: 1601 32nd Street Apt. 221 Wichita Falls TX 76302	Home Address: 1601 32nd Street Apt. 221 Wichita Falls TX 76302
Phone Number: 9402243058	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments: Employee quit to seek another job.

Request ID: 2783	Status: COMPLETE
Request Date: 2019-02-26	Status Date: 2019-02-26
Member Name: Kassi Fugett	Date of Birth: 1979-01-17
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 462453976
Gender: F	Submitted By: 335450
Mailing Address: 1601 32nd Street Apt. 221 Wichita Falls TX 76302	Home Address: 1601 32nd Street Apt. 221 Wichita Falls TX 76302
Phone Number: 9402243058	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments: Employee quit to seek another job.

Request ID: 2783	Status: COMPLETE
Request Date: 2019-02-26	Status Date: 2019-02-26
Member Name: Kassi Fugett	Date of Birth: 1979-01-17
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 462453976
Gender: F	Submitted By: 335450
Mailing Address: 1601 32nd Street Apt. 221 Wichita Falls TX 76302	Home Address: 1601 32nd Street Apt. 221 Wichita Falls TX 76302
Phone Number: 9402243058	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2783	Status: COMPLETE
Request Date: 2016-07-26	Status Date: 2016-07-26
Member Name: Kassi Fugett	Date of Birth: 1979-01-17
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 462453976
Gender: F	Submitted By: 56174
Mailing Address: 1601 32nd Street Apt. 221 Wichita Falls TX 76302	Home Address: 1601 32nd Street Apt. 221 Wichita Falls TX 76302
Phone Number: 9402243058	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2840	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Dallas Burnside	Date of Birth: 1985-08-02
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 528996343
Gender: M	Submitted By: 120043
Mailing Address: 371 Grandover Ct Las Vegas NV 89148
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2840	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Ashley Burnside	Date of Birth: 1988-07-31
Employer ID: WIRE	Member ID: 12345678902
Effective Date: 2019-03-01	SSN: 525879023
Gender: F	Submitted By: 120043
Mailing Address: 371 Grandover Ct Las Vegas NV 89148
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2840	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Ryan Lee Burnside	Date of Birth: 2013-02-20
Employer ID: WIRE	Member ID: 12345678903
Effective Date: 2019-03-01	SSN: 709962508
Gender: F	Submitted By: 120043
Mailing Address: 371 Grandover Ct Las Vegas NV 89148
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2840	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Rocklynn Ashelle Burnside	Date of Birth: 2015-06-10
Employer ID: WIRE	Member ID: 12345678904
Effective Date: 2019-03-01	SSN: 719397582
Gender: F	Submitted By: 120043
Mailing Address: 371 Grandover Ct Las Vegas NV 89148
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2841	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Jeremy- Ethan Salvador	Date of Birth: 1996-11-21
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 575778363
Gender: M	Submitted By: 120043
Mailing Address: 1640 Houghtailing St Honolulu HI 96817
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2842	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Adrianne Paguirigan-Lipata	Date of Birth: 1990-12-04
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 644696530
Gender: F	Submitted By: 120043
Mailing Address: 3210 Del Marino St Las Vegas NV 89121
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments: term app eff. 8-1-16.

Request ID: 2842	Status: COMPLETE
Request Date: 2016-08-01	Status Date: 2016-08-01
Member Name: Adrianne Paguirigan-Lipata	Date of Birth: 1990-12-04
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 644696530
Gender: F	Submitted By: 62307
Mailing Address: 3210 Del Marino St Las Vegas NV 89121
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments: term app eff. 8-1-16.

Request ID: 2842	Status: COMPLETE
Request Date: 2016-08-01	Status Date: 2016-08-01
Member Name: Adrianne Paguirigan-Lipata	Date of Birth: 1990-12-04
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 644696530
Gender: F	Submitted By: 62307
Mailing Address: 3210 Del Marino St Las Vegas NV 89121
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2842	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Adrianne Paguirigan-Lipata	Date of Birth: 1990-12-04
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 644696530
Gender: F	Submitted By: 120043
Mailing Address: 3210 Del Marino St Las Vegas NV 89121
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2843	Status: COMPLETE
Request Date: 2016-08-01	Status Date: 2016-08-01
Member Name: Shaohui Chen	Date of Birth: 1993-06-18
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613598323
Gender: U	Submitted By: 62307
Mailing Address: 72 Ledyard St. San Francisco CA 94124
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments: term app eff. 8/1/16

Request ID: 2843	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Shaohui Chen	Date of Birth: 1993-06-18
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613598323
Gender: U	Submitted By: 120043
Mailing Address: 72 Ledyard St. San Francisco CA 94124
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments: term app eff. 8/1/16

Request ID: 2843	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Shaohui Chen	Date of Birth: 1993-06-18
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613598323
Gender: U	Submitted By: 120043
Mailing Address: 72 Ledyard St. San Francisco CA 94124
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2843	Status: COMPLETE
Request Date: 2016-08-01	Status Date: 2016-08-01
Member Name: Shaohui Chen	Date of Birth: 1993-06-18
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613598323
Gender: U	Submitted By: 62307
Mailing Address: 72 Ledyard St. San Francisco CA 94124
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2844	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Caelen McCaslin	Date of Birth: 1991-05-29
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 376217543
Gender: F	Submitted By: 120043
Mailing Address: 1715 Jr Williams Rd Dandridge TN 37725
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2844	Status: COMPLETE
Request Date: 2019-02-28	Status Date: 2019-02-28
Member Name: Caelen McCaslin	Date of Birth: 1991-05-29
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 376217543
Gender: F	Submitted By: 120043
Mailing Address: 1715 Jr Williams Rd Dandridge TN 37725
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments: term app eff. 8/1/16.

Request ID: 2844	Status: COMPLETE
Request Date: 2016-08-01	Status Date: 2016-08-01
Member Name: Caelen McCaslin	Date of Birth: 1991-05-29
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 376217543
Gender: F	Submitted By: 62307
Mailing Address: 1715 Jr Williams Rd Dandridge TN 37725
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments: term app eff. 8/1/16.

Request ID: 2844	Status: COMPLETE
Request Date: 2016-08-01	Status Date: 2016-08-01
Member Name: Caelen McCaslin	Date of Birth: 1991-05-29
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 376217543
Gender: F	Submitted By: 62307
Mailing Address: 1715 Jr Williams Rd Dandridge TN 37725
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2894	Status: COMPLETE
Request Date: 2019-03-01	Status Date: 2019-03-01
Member Name: Joseph Collins	Date of Birth: 1967-09-06
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 550257950
Gender: M	Submitted By: 332291
Mailing Address: 1620 E. Hoquiam Rd Hoquiam WA 98550	Home Address: 1620 E. Hoquiam Rd Hoquiam WA 98550
Phone Number: 3608900900	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2898	Status: COMPLETE
Request Date: 2019-03-01	Status Date: 2019-03-01
Member Name: Kassandra Mejia	Date of Birth: 1986-02-15
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 451771309
Gender: F	Submitted By: 205201
Mailing Address: 608 Santa Elena St Weslaco TX 78596	Home Address: 608 Santa Elena St Weslaco TX 78596
Phone Number: 9566840018	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2899	Status: COMPLETE
Request Date: 2019-03-01	Status Date: 2019-03-01
Member Name: Jeremy-Ethan Salvador	Date of Birth: 1996-11-21
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 575778363
Gender: M	Submitted By: 205201
Mailing Address: 1640 Houghtailing St Honolulu HI 96817	Home Address: 1640 Houghtailing St Honolulu HI 96817
Phone Number: 8087297254	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2900	Status: COMPLETE
Request Date: 2019-03-01	Status Date: 2019-03-01
Member Name: Shaohui Chen	Date of Birth: 1993-06-18
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 613598323
Gender: M	Submitted By: 205201
Mailing Address: 72 Ledyard St. San Francisco CA 94124	Home Address: 72 Ledyard St. San Francisco CA 94124
Phone Number: 4157288828	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2901	Status: COMPLETE
Request Date: 2019-03-01	Status Date: 2019-03-01
Member Name: Adrianne Paguirigan Lipata	Date of Birth: 1990-12-04
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 644696530
Gender: U	Submitted By: 205201
Mailing Address: 3210 Del Marino St Las Vegas NV 89121	Home Address: 3210 Del Marino St Las Vegas NV 89121
Phone Number: 7024750456	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2905	Status: COMPLETE
Request Date: 2016-08-04	Status Date: 2016-08-04
Member Name: Jose Luis Rodriguez	Date of Birth: 1995-06-08
Employer ID: BSR	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 530877448
Gender: M	Submitted By: 58902
Mailing Address: 2905 King Midas Way Las Vegas NV 89102	Home Address: 2905 King Midas Way Las Vegas NV 89102
Phone Number: 7022736319	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2905	Status: COMPLETE
Request Date: 2019-03-02	Status Date: 2019-03-02
Member Name: Jose Luis Rodriguez	Date of Birth: 1995-06-08
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 530877448
Gender: M	Submitted By: 205201
Mailing Address: 2905 King Midas Way Las Vegas NV 89102	Home Address: 2905 King Midas Way Las Vegas NV 89102
Phone Number: 7022736319	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2906	Status: COMPLETE
Request Date: 2016-08-04	Status Date: 2016-08-04
Member Name: Leslie N Gregory	Date of Birth: 1984-07-23
Employer ID: BSR	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 535612755
Gender: F	Submitted By: 58902
Mailing Address: 2019 Henkle Street Raymond WA 98577	Home Address: 2019 Henkle Street Raymond WA 98577
Phone Number: 3607636355	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2906	Status: COMPLETE
Request Date: 2019-03-02	Status Date: 2019-03-02
Member Name: Leslie N Gregory	Date of Birth: 1984-07-23
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 535612755
Gender: F	Submitted By: 332291
Mailing Address: 2019 Henkle Street Raymond WA 98577	Home Address: 2019 Henkle Street Raymond WA 98577
Phone Number: 3607636355	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2906	Status: COMPLETE
Request Date: 2016-08-04	Status Date: 2016-08-04
Member Name: Natalia Gregory	Date of Birth: 2009-11-16
Employer ID: BSR	Member ID: 12345678902
Effective Date: 2019-03-01	SSN: 539673190
Gender: F	Submitted By: 58902
Mailing Address: 2019 Henkle Street Raymond WA 98577
Phone Number: 3607636355	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2906	Status: COMPLETE
Request Date: 2019-03-02	Status Date: 2019-03-02
Member Name: Natalia Gregory	Date of Birth: 2009-11-16
Employer ID: VAUGHAN	Member ID: 12345678902
Effective Date: 2019-03-01	SSN: 539673190
Gender: F	Submitted By: 332291
Mailing Address: 2019 Henkle Street Raymond WA 98577
Phone Number: 3607636355	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2906	Status: COMPLETE
Request Date: 2016-08-04	Status Date: 2016-08-04
Member Name: Nathaniel Gregory	Date of Birth: 2016-10-08
Employer ID: BSR	Member ID: 12345678903
Effective Date: 2019-03-01	SSN: 046931184
Gender: M	Submitted By: 58902
Mailing Address: 2019 Henkle Street Raymond WA 98577
Phone Number: 3607636355	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2906	Status: COMPLETE
Request Date: 2019-03-02	Status Date: 2019-03-02
Member Name: Nathaniel Gregory	Date of Birth: 2016-10-08
Employer ID: VAUGHAN	Member ID: 12345678903
Effective Date: 2019-03-01	SSN: 046931184
Gender: M	Submitted By: 332291
Mailing Address: 2019 Henkle Street Raymond WA 98577
Phone Number: 3607636355	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 2913	Status: COMPLETE
Request Date: 2016-08-04	Status Date: 2016-08-04
Member Name: test test	Date of Birth: 1981-08-01
Employer ID: BSR	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test AZ 85044
Phone Number: 4802205619	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments: ////test response

Request ID: 2945	Status: COMPLETE
Request Date: 2019-03-04	Status Date: 2019-03-04
Member Name: Sabrina Italia	Date of Birth: 1969-10-23
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 552737543
Gender: F	Submitted By: 333976
Mailing Address: 926 Amhurst Ct Concord CA 94518	Home Address: 926 Amhurst Ct Concord CA 94518
Phone Number: 9257056231	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 2945	Status: COMPLETE
Request Date: 2019-03-04	Status Date: 2019-03-04
Member Name: Antonio Italia	Date of Birth: 2005-03-16
Employer ID: BURK	Member ID: 12345678902
Effective Date: 2019-03-01	SSN: 606516630
Gender: M	Submitted By: 333976
Mailing Address: 926 Amhurst Ct Concord CA 94518
Phone Number: 9257056231	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 3002	Status: COMPLETE
Request Date: 2016-08-09	Status Date: 2016-08-09
Member Name: Sheena Moreira	Date of Birth: 1987-05-16
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 576359885
Gender: F	Submitted By: 56536
Mailing Address: 955 Hoolaulea St Hilo HI 96720
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3002	Status: COMPLETE
Request Date: 2019-03-04	Status Date: 2019-03-04
Member Name: Sheena Moreira	Date of Birth: 1987-05-16
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 576359885
Gender: F	Submitted By: 120043
Mailing Address: 955 Hoolaulea St Hilo HI 96720
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3002	Status: COMPLETE
Request Date: 2019-03-04	Status Date: 2019-03-04
Member Name: Sheena Moreira	Date of Birth: 1987-05-16
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 576359885
Gender: F	Submitted By: 120043
Mailing Address: 955 Hoolaulea St Hilo HI 96720
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3002	Status: COMPLETE
Request Date: 2016-08-09	Status Date: 2016-08-09
Member Name: Sheena Moreira	Date of Birth: 1987-05-16
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 576359885
Gender: F	Submitted By: 56536
Mailing Address: 955 Hoolaulea St Hilo HI 96720
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3003	Status: COMPLETE
Request Date: 2019-03-04	Status Date: 2019-03-04
Member Name: vanessa Berry	Date of Birth: 1989-08-19
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 607286428
Gender: F	Submitted By: 120043
Mailing Address: 11997 Haven St Las Vegas NV 89183
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3003	Status: COMPLETE
Request Date: 2019-03-04	Status Date: 2019-03-04
Member Name: Jessica Honey Berry	Date of Birth: 2008-07-12
Employer ID: WIRE	Member ID: 12345678902
Effective Date: 2019-03-01	SSN: 611714362
Gender: F	Submitted By: 120043
Mailing Address: 11997 Haven St Las Vegas NV 89183
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3003	Status: COMPLETE
Request Date: 2019-03-04	Status Date: 2019-03-04
Member Name: Michael Robert Berry	Date of Birth: 2011-11-23
Employer ID: WIRE	Member ID: 12345678903
Effective Date: 2019-03-01	SSN: 796598277
Gender: M	Submitted By: 120043
Mailing Address: 11997 Haven St Las Vegas NV 89183
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3004	Status: COMPLETE
Request Date: 2019-03-04	Status Date: 2019-03-04
Member Name: ishamina simpson	Date of Birth: 1983-08-24
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 551771194
Gender: F	Submitted By: 120043
Mailing Address: 5850 sky pointe dr unit 1145 las vegas NV 89130
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3202	Status: COMPLETE
Request Date: 2016-08-11	Status Date: 2016-08-11
Member Name: Alejandro Rincon	Date of Birth: 1990-09-30
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 517365647
Gender: M	Submitted By: 56536
Mailing Address: 31919 SW Peach Cove Road West Linn OR 97068
Phone Number: 9565106581	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3202	Status: COMPLETE
Request Date: 2019-03-12	Status Date: 2019-03-12
Member Name: Alejandro Rincon	Date of Birth: 1990-09-30
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 517365647
Gender: M	Submitted By: 294404
Mailing Address: 31919 SW Peach Cove Road West Linn OR 97068
Phone Number: 9565106581	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3202	Status: COMPLETE
Request Date: 2019-03-12	Status Date: 2019-03-12
Member Name: Alejandro Rincon	Date of Birth: 1990-09-30
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 517365647
Gender: M	Submitted By: 294404
Mailing Address: 31919 SW Peach Cove Road West Linn OR 97068
Phone Number: 9565106581	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 3202	Status: COMPLETE
Request Date: 2016-08-11	Status Date: 2016-08-11
Member Name: Alejandro Rincon	Date of Birth: 1990-09-30
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 517365647
Gender: M	Submitted By: 56536
Mailing Address: 31919 SW Peach Cove Road West Linn OR 97068
Phone Number: 9565106581	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 3202	Status: COMPLETE
Request Date: 2016-08-11	Status Date: 2016-08-11
Member Name: null null null	Date of Birth: null
Employer ID: ENF	Member ID: 64728519601
Effective Date: 2016-09-01	SSN: null
Gender: U	Submitted By: 56536
Mailing Address: 41 TOWER ST HUNTINGTON STATION NY 11746
Phone Number:	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3202	Status: COMPLETE
Request Date: 2019-03-12	Status Date: 2019-03-12
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 64728519601
Effective Date: 2016-09-01	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 41 TOWER ST HUNTINGTON STATION NY 11746
Phone Number:	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3202	Status: COMPLETE
Request Date: 2019-03-12	Status Date: 2019-03-12
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 64728519601
Effective Date: 2016-09-01	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 41 TOWER ST HUNTINGTON STATION NY 11746
Phone Number:	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 3202	Status: COMPLETE
Request Date: 2016-08-11	Status Date: 2016-08-11
Member Name: null null null	Date of Birth: null
Employer ID: ENF	Member ID: 64728519601
Effective Date: 2016-09-01	SSN: null
Gender: U	Submitted By: 56536
Mailing Address: 41 TOWER ST HUNTINGTON STATION NY 11746
Phone Number:	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 3222	Status: COMPLETE
Request Date: 2016-08-11	Status Date: 2016-08-11
Member Name: Isreal Godinez Aguilar	Date of Birth: 1993-01-03
Employer ID: BSR	Member ID: 128101
Effective Date: 2016-07-01	SSN: 623118763
Gender: M	Submitted By: 58902
Mailing Address: 316 S. 6th Street Yakima WA 98901
Phone Number: 5097893131	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3222	Status: COMPLETE
Request Date: 2019-03-12	Status Date: 2019-03-12
Member Name: Isreal Godinez Aguilar	Date of Birth: 1993-01-03
Employer ID: null	Member ID: 128101
Effective Date: 2016-07-01	SSN: 623118763
Gender: M	Submitted By: 294404
Mailing Address: 316 S. 6th Street Yakima WA 98901
Phone Number: 5097893131	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3222	Status: COMPLETE
Request Date: 2019-03-12	Status Date: 2019-03-12
Member Name: Isreal Godinez Aguilar	Date of Birth: 1993-01-03
Employer ID: null	Member ID: 128101
Effective Date: 2016-07-01	SSN: 623118763
Gender: M	Submitted By: 294404
Mailing Address: 316 S. 6th Street Yakima WA 98901
Phone Number: 5097893131	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3222	Status: COMPLETE
Request Date: 2016-08-11	Status Date: 2016-08-11
Member Name: Isreal Godinez Aguilar	Date of Birth: 1993-01-03
Employer ID: BSR	Member ID: 128101
Effective Date: 2016-07-01	SSN: 623118763
Gender: M	Submitted By: 58902
Mailing Address: 316 S. 6th Street Yakima WA 98901
Phone Number: 5097893131	Email Address:
Selected Plan: MCS178	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3240	Status: COMPLETE
Request Date: 2019-03-14	Status Date: 2019-03-14
Member Name: Alejandra F Silva	Date of Birth: 1995-08-14
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 608849430
Gender: F	Submitted By: 333976
Mailing Address: 5919 Converse Ave Los Angeles CA 90001	Home Address: 5919 Converse Ave Los Angeles CA 90001
Phone Number: 3239157215	Email Address:
Selected Plan: CP4371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 3256	Status: COMPLETE
Request Date: 2019-03-18	Status Date: 2019-03-18
Member Name: Tasheka Moore	Date of Birth: 1979-07-29
Employer ID: CALHOUN	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 247477865
Gender: F	Submitted By: 234230
Mailing Address: 65 Barber Rd Covington GA 30016	Home Address: 65 Barber Rd Covington GA 30016
Phone Number:	Email Address:
Selected Plan: EL5100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3282	Status: COMPLETE
Request Date: 2016-08-16	Status Date: 2016-08-16
Member Name: Laquita Huston	Date of Birth: 1985-11-23
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 252534401
Gender: F	Submitted By: 62307
Mailing Address: 1003 West 41st Street Savannah GA 31419	Home Address: 1003 West 41st Street Savannah GA 31419
Phone Number:	Email Address:
Selected Plan: ZCP009	Medical: Yes Vision: No Dental: No
Comments: term eff. 9/1/16

Request ID: 3282	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Laquita Huston	Date of Birth: 1985-11-23
Employer ID: CALHOUN	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 252534401
Gender: F	Submitted By: 234230
Mailing Address: 1003 West 41st Street Savannah GA 31419	Home Address: 1003 West 41st Street Savannah GA 31419
Phone Number:	Email Address:
Selected Plan: ZCP009	Medical: Yes Vision: No Dental: No
Comments: term eff. 9/1/16

Request ID: 3282	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Laquita Huston	Date of Birth: 1985-11-23
Employer ID: CALHOUN	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 252534401
Gender: F	Submitted By: 234230
Mailing Address: 1003 West 41st Street Savannah GA 31419	Home Address: 1003 West 41st Street Savannah GA 31419
Phone Number:	Email Address:
Selected Plan: ZCP009	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3282	Status: COMPLETE
Request Date: 2016-08-16	Status Date: 2016-08-16
Member Name: Laquita Huston	Date of Birth: 1985-11-23
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-03-01	SSN: 252534401
Gender: F	Submitted By: 62307
Mailing Address: 1003 West 41st Street Savannah GA 31419	Home Address: 1003 West 41st Street Savannah GA 31419
Phone Number:	Email Address:
Selected Plan: ZCP009	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3302	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Allen Lyons	Date of Birth: 1990-11-15
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 439796554
Gender: M	Submitted By: 294404
Mailing Address: 920 A Hassen Dr Mexico MO 65265	Home Address: 920 A Hassen Dr Mexico MO 65265
Phone Number: 5739750462	Email Address:
Selected Plan: MCS116	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3302	Status: COMPLETE
Request Date: 2016-08-17	Status Date: 2016-08-17
Member Name: Allen Lyons	Date of Birth: 1990-11-15
Employer ID: JES	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 439796554
Gender: M	Submitted By: 57087
Mailing Address: 920 A Hassen Dr Mexico MO 65265	Home Address: 920 A Hassen Dr Mexico MO 65265
Phone Number: 5739750462	Email Address:
Selected Plan: MCS116	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3302	Status: COMPLETE
Request Date: 2016-08-17	Status Date: 2016-08-17
Member Name: Allen Lyons	Date of Birth: 1990-11-15
Employer ID: JES	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 439796554
Gender: M	Submitted By: 57087
Mailing Address: 920 A Hassen Dr Mexico MO 65265	Home Address: 920 A Hassen Dr Mexico MO 65265
Phone Number: 5739750462	Email Address:
Selected Plan: MCS116	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3302	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Allen Lyons	Date of Birth: 1990-11-15
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-08-01	SSN: 439796554
Gender: M	Submitted By: 294404
Mailing Address: 920 A Hassen Dr Mexico MO 65265	Home Address: 920 A Hassen Dr Mexico MO 65265
Phone Number: 5739750462	Email Address:
Selected Plan: MCS116	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3322	Status: COMPLETE
Request Date: 2016-08-19	Status Date: 2016-08-19
Member Name: Ashley Haller	Date of Birth: 1992-07-26
Employer ID: JES	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 486086719
Gender: F	Submitted By: 57087
Mailing Address: 2419 Laurwood Drive Holts Summit MO 65043	Home Address: 2419 Laurwood Drive Holts Summit MO 65043
Phone Number: 5738267759	Email Address:
Selected Plan: MCS116	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3322	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Ashley Haller	Date of Birth: 1992-07-26
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 486086719
Gender: F	Submitted By: 294404
Mailing Address: 2419 Laurwood Drive Holts Summit MO 65043	Home Address: 2419 Laurwood Drive Holts Summit MO 65043
Phone Number: 5738267759	Email Address:
Selected Plan: MCS116	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3322	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Ashley Haller	Date of Birth: 1992-07-26
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 486086719
Gender: F	Submitted By: 294404
Mailing Address: 2419 Laurwood Drive Holts Summit MO 65043	Home Address: 2419 Laurwood Drive Holts Summit MO 65043
Phone Number: 5738267759	Email Address:
Selected Plan: MCS116	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3322	Status: COMPLETE
Request Date: 2016-08-19	Status Date: 2016-08-19
Member Name: Ashley Haller	Date of Birth: 1992-07-26
Employer ID: JES	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 486086719
Gender: F	Submitted By: 57087
Mailing Address: 2419 Laurwood Drive Holts Summit MO 65043	Home Address: 2419 Laurwood Drive Holts Summit MO 65043
Phone Number: 5738267759	Email Address:
Selected Plan: MCS116	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3324	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Amanda J Mohn	Date of Birth: 1991-10-07
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-07-01	SSN: 395088233
Gender: F	Submitted By: 294404
Mailing Address: 141 Bader St. #18 Green Bay WI 54302	Home Address: 141 Bader St. #18 Green Bay WI 54302
Phone Number: 9202655715	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3324	Status: COMPLETE
Request Date: 2016-08-19	Status Date: 2016-08-19
Member Name: Amanda J Mohn	Date of Birth: 1991-10-07
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-07-01	SSN: 395088233
Gender: F	Submitted By: 55914
Mailing Address: 141 Bader St. #18 Green Bay WI 54302	Home Address: 141 Bader St. #18 Green Bay WI 54302
Phone Number: 9202655715	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3324	Status: COMPLETE
Request Date: 2016-08-19	Status Date: 2016-08-19
Member Name: Amanda J Mohn	Date of Birth: 1991-10-07
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-07-01	SSN: 395088233
Gender: F	Submitted By: 55914
Mailing Address: 141 Bader St. #18 Green Bay WI 54302	Home Address: 141 Bader St. #18 Green Bay WI 54302
Phone Number: 9202655715	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3324	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Amanda J Mohn	Date of Birth: 1991-10-07
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-07-01	SSN: 395088233
Gender: F	Submitted By: 294404
Mailing Address: 141 Bader St. #18 Green Bay WI 54302	Home Address: 141 Bader St. #18 Green Bay WI 54302
Phone Number: 9202655715	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3382	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Habiibah I Pate	Date of Birth: 1997-07-01
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 517314346
Gender: F	Submitted By: 294404
Mailing Address: 16 Cedar Hills Estates Whitehall MT 59759	Home Address: 16 Cedar Hills Estates Whitehall MT 59759
Phone Number: 4064916125	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3382	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Habiibah I Pate	Date of Birth: 1997-07-01
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 517314346
Gender: F	Submitted By: 48576
Mailing Address: 16 Cedar Hills Estates Whitehall MT 59759	Home Address: 16 Cedar Hills Estates Whitehall MT 59759
Phone Number: 4064916125	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3382	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Habiibah I Pate	Date of Birth: 1997-07-01
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 517314346
Gender: F	Submitted By: 48576
Mailing Address: 16 Cedar Hills Estates Whitehall MT 59759	Home Address: 16 Cedar Hills Estates Whitehall MT 59759
Phone Number: 4064916125	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3382	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Habiibah I Pate	Date of Birth: 1997-07-01
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 517314346
Gender: F	Submitted By: 294404
Mailing Address: 16 Cedar Hills Estates Whitehall MT 59759	Home Address: 16 Cedar Hills Estates Whitehall MT 59759
Phone Number: 4064916125	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3383	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Angelo L Tolfa II	Date of Birth: 1986-07-19
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 194665694
Gender: M	Submitted By: 294404
Mailing Address: 1 Eastwood Drive Bozeman MT 59718	Home Address: 1 Eastwood Drive Bozeman MT 59718
Phone Number: 4065482522	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3383	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Angelo L Tolfa II	Date of Birth: 1986-07-19
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 194665694
Gender: M	Submitted By: 48576
Mailing Address: 1 Eastwood Drive Bozeman MT 59718	Home Address: 1 Eastwood Drive Bozeman MT 59718
Phone Number: 4065482522	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3383	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Angelo L Tolfa II	Date of Birth: 1986-07-19
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 194665694
Gender: M	Submitted By: 48576
Mailing Address: 1 Eastwood Drive Bozeman MT 59718	Home Address: 1 Eastwood Drive Bozeman MT 59718
Phone Number: 4065482522	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3383	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Angelo L Tolfa II	Date of Birth: 1986-07-19
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 194665694
Gender: M	Submitted By: 294404
Mailing Address: 1 Eastwood Drive Bozeman MT 59718	Home Address: 1 Eastwood Drive Bozeman MT 59718
Phone Number: 4065482522	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3384	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Jason R Cargill	Date of Birth: 1972-11-18
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 474063611
Gender: M	Submitted By: 48576
Mailing Address: 35 Mule Buck Tr Bozeman MT 59715	Home Address: 35 Mule Buck Tr Bozeman MT 59715
Phone Number: 4065812790	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3384	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Jason R Cargill	Date of Birth: 1972-11-18
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 474063611
Gender: M	Submitted By: 294404
Mailing Address: 35 Mule Buck Tr Bozeman MT 59715	Home Address: 35 Mule Buck Tr Bozeman MT 59715
Phone Number: 4065812790	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3384	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Jason R Cargill	Date of Birth: 1972-11-18
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 474063611
Gender: M	Submitted By: 294404
Mailing Address: 35 Mule Buck Tr Bozeman MT 59715	Home Address: 35 Mule Buck Tr Bozeman MT 59715
Phone Number: 4065812790	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3384	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Jason R Cargill	Date of Birth: 1972-11-18
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 474063611
Gender: M	Submitted By: 48576
Mailing Address: 35 Mule Buck Tr Bozeman MT 59715	Home Address: 35 Mule Buck Tr Bozeman MT 59715
Phone Number: 4065812790	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3385	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Jason R Cargill	Date of Birth: 1972-11-18
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 474063611
Gender: M	Submitted By: 294404
Mailing Address: 35 Mule Buck Tr Bozeman MT 59715	Home Address: 35 Mule Buck Tr Bozeman MT 59715
Phone Number: 4065812790	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3385	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Jason R Cargill	Date of Birth: 1972-11-18
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 474063611
Gender: M	Submitted By: 48576
Mailing Address: 35 Mule Buck Tr Bozeman MT 59715	Home Address: 35 Mule Buck Tr Bozeman MT 59715
Phone Number: 4065812790	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3385	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Jason R Cargill	Date of Birth: 1972-11-18
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 474063611
Gender: M	Submitted By: 48576
Mailing Address: 35 Mule Buck Tr Bozeman MT 59715	Home Address: 35 Mule Buck Tr Bozeman MT 59715
Phone Number: 4065812790	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3385	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Jason R Cargill	Date of Birth: 1972-11-18
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 474063611
Gender: M	Submitted By: 294404
Mailing Address: 35 Mule Buck Tr Bozeman MT 59715	Home Address: 35 Mule Buck Tr Bozeman MT 59715
Phone Number: 4065812790	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3386	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Katherine D Neiman	Date of Birth: 1988-10-16
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 604481251
Gender: F	Submitted By: 294404
Mailing Address: 813 W Villard, #78 Bozeman MT 59715	Home Address: 813 W Villard, #78 Bozeman MT 59715
Phone Number: 4065463647	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3386	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Katherine D Neiman	Date of Birth: 1988-10-16
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 604481251
Gender: F	Submitted By: 48576
Mailing Address: 813 W Villard, #78 Bozeman MT 59715	Home Address: 813 W Villard, #78 Bozeman MT 59715
Phone Number: 4065463647	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3386	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Katherine D Neiman	Date of Birth: 1988-10-16
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 604481251
Gender: F	Submitted By: 48576
Mailing Address: 813 W Villard, #78 Bozeman MT 59715	Home Address: 813 W Villard, #78 Bozeman MT 59715
Phone Number: 4065463647	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3386	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Katherine D Neiman	Date of Birth: 1988-10-16
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 604481251
Gender: F	Submitted By: 294404
Mailing Address: 813 W Villard, #78 Bozeman MT 59715	Home Address: 813 W Villard, #78 Bozeman MT 59715
Phone Number: 4065463647	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3387	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Wendy D Wren	Date of Birth: 1969-06-27
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 551472751
Gender: F	Submitted By: 294404
Mailing Address: 777 Haggerty Ln #11 Bozeman MT 59715	Home Address: 777 Haggerty Ln #11 Bozeman MT 59715
Phone Number: 4064511999	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3387	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Wendy D Wren	Date of Birth: 1969-06-27
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 551472751
Gender: F	Submitted By: 48576
Mailing Address: 777 Haggerty Ln #11 Bozeman MT 59715	Home Address: 777 Haggerty Ln #11 Bozeman MT 59715
Phone Number: 4064511999	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3387	Status: COMPLETE
Request Date: 2016-08-26	Status Date: 2016-08-26
Member Name: Wendy D Wren	Date of Birth: 1969-06-27
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 551472751
Gender: F	Submitted By: 48576
Mailing Address: 777 Haggerty Ln #11 Bozeman MT 59715	Home Address: 777 Haggerty Ln #11 Bozeman MT 59715
Phone Number: 4064511999	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3387	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Wendy D Wren	Date of Birth: 1969-06-27
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-09-01	SSN: 551472751
Gender: F	Submitted By: 294404
Mailing Address: 777 Haggerty Ln #11 Bozeman MT 59715	Home Address: 777 Haggerty Ln #11 Bozeman MT 59715
Phone Number: 4064511999	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3397	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Richard Boyer	Date of Birth: 1988-04-17
Employer ID: VAUGHAN	Member ID: 64801074101
Effective Date: 2019-02-22	SSN: 533150837
Gender: M	Submitted By: 332291
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3397	Status: COMPLETE
Request Date: 2019-03-19	Status Date: 2019-03-19
Member Name: Richard Boyer	Date of Birth: 2019-02-22
Employer ID: VAUGHAN	Member ID: 64801074102
Effective Date: 2019-02-22	SSN: 478454300
Gender: M	Submitted By: 332291
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3643	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Arnulfa Sixto Barcena	Date of Birth: 1975-08-03
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 527478864
Gender: F	Submitted By: 56536
Mailing Address: 436 Barley Street Woodburn OR 97071
Phone Number:	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3644	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Eloisa Lopez Ramirez	Date of Birth: 1974-07-17
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 543874563
Gender: F	Submitted By: 56536
Mailing Address: 290 Andrea Woodburn OR 97071
Phone Number: 9713381769	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3645	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Asuncion Cruz Velasco	Date of Birth: 1973-08-15
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 542963295
Gender: F	Submitted By: 56536
Mailing Address: 706 Young Street Woodburn OR 97071
Phone Number:	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3646	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Juan Tinoco Ornelas	Date of Birth: 1990-12-05
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 869912125
Gender: M	Submitted By: 56536
Mailing Address: 2709 Strasburg Drive Forest Grove OR 97116
Phone Number: 5038663987	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3647	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Memo de Jesus Rosales	Date of Birth: 1993-09-22
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 542084423
Gender: M	Submitted By: 56536
Mailing Address: 910 E 7th Street Newberg OR 97132
Phone Number: 9712462891	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3648	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Minerva Devora Caballero	Date of Birth: 1965-12-19
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 543527753
Gender: F	Submitted By: 56536
Mailing Address: 1582 James Street Apt. B Woodburn OR 97071
Phone Number: 9713383764	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3649	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Ricardo de Jesus	Date of Birth: 1986-05-01
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 567094865
Gender: M	Submitted By: 56536
Mailing Address: 217 W Illinois Street Newberg OR 97132
Phone Number: 5037244069	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3650	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Selerino Tenorio	Date of Birth: 1980-01-12
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 619325783
Gender: M	Submitted By: 56536
Mailing Address: 217 W Illinois Street Newberg OR 97132
Phone Number: 5038575854	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3659	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Callen J Conover	Date of Birth: 1967-02-19
Employer ID: NESS	Member ID: 2485801
Effective Date: 2016-10-01	SSN: 532885229
Gender: M	Submitted By: 64974
Mailing Address: 31711 161 St. PL SE Auburn WA 98092
Phone Number: 2067692476	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3660	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: John D Duot	Date of Birth: 1986-07-12
Employer ID: NESS	Member ID: 2481201
Effective Date: 2016-10-01	SSN: 536594493
Gender: M	Submitted By: 64974
Mailing Address: 2012 S. 310th St Federal Way WA 98003
Phone Number: 2065828614	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3661	Status: COMPLETE
Request Date: 2019-03-21	Status Date: 2019-03-21
Member Name: Christopher Curry	Date of Birth: 1965-08-30
Employer ID: null	Member ID: 2482401
Effective Date: 2016-10-01	SSN: 573459345
Gender: M	Submitted By: 333418
Mailing Address: 412 E. Novak Ln #C-202 Kent WA 98032
Phone Number: 2533449348	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3661	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Christopher Curry	Date of Birth: 1965-08-30
Employer ID: NESS	Member ID: 2482401
Effective Date: 2016-10-01	SSN: 573459345
Gender: M	Submitted By: 64974
Mailing Address: 412 E. Novak Ln #C-202 Kent WA 98032
Phone Number: 2533449348	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3661	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: Christopher Curry	Date of Birth: 1965-08-30
Employer ID: NESS	Member ID: 2482401
Effective Date: 2016-10-01	SSN: 573459345
Gender: M	Submitted By: 64974
Mailing Address: 412 E. Novak Ln #C-202 Kent WA 98032
Phone Number: 2533449348	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments: Please update address

Request ID: 3661	Status: COMPLETE
Request Date: 2019-03-21	Status Date: 2019-03-21
Member Name: Christopher Curry	Date of Birth: 1965-08-30
Employer ID: null	Member ID: 2482401
Effective Date: 2016-10-01	SSN: 573459345
Gender: M	Submitted By: 333418
Mailing Address: 412 E. Novak Ln #C-202 Kent WA 98032
Phone Number: 2533449348	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments: Please update address

Request ID: 3661	Status: COMPLETE
Request Date: 2019-03-21	Status Date: 2019-03-21
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 17635485201
Effective Date: 2016-10-01	SSN: null
Gender: U	Submitted By: 333418
Mailing Address: 530 New Morn Dr Mcdonough GA 30253-8340	Home Address: 530 New Morn Dr Mcdonough GA 30253-8340
Phone Number:	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3661	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: null null null	Date of Birth: null
Employer ID: NESS	Member ID: 17635485201
Effective Date: 2016-10-01	SSN: null
Gender: U	Submitted By: 64974
Mailing Address: 530 New Morn Dr Mcdonough GA 30253-8340	Home Address: 530 New Morn Dr Mcdonough GA 30253-8340
Phone Number:	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3661	Status: COMPLETE
Request Date: 2016-09-27	Status Date: 2016-09-27
Member Name: null null null	Date of Birth: null
Employer ID: NESS	Member ID: 17635485201
Effective Date: 2016-10-01	SSN: null
Gender: U	Submitted By: 64974
Mailing Address: 530 New Morn Dr Mcdonough GA 30253-8340	Home Address: 530 New Morn Dr Mcdonough GA 30253-8340
Phone Number:	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments: Please update address

Request ID: 3661	Status: COMPLETE
Request Date: 2019-03-21	Status Date: 2019-03-21
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 17635485201
Effective Date: 2016-10-01	SSN: null
Gender: U	Submitted By: 333418
Mailing Address: 530 New Morn Dr Mcdonough GA 30253-8340	Home Address: 530 New Morn Dr Mcdonough GA 30253-8340
Phone Number:	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments: Please update address

Request ID: 3683	Status: COMPLETE
Request Date: 2019-03-21	Status Date: 2019-03-21
Member Name: Leslie Gregory	Date of Birth: 1984-07-23
Employer ID: VAUGHAN	Member ID: 19855452301
Effective Date: 2019-03-01	SSN: 535612755
Gender: F	Submitted By: 332291
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3683	Status: COMPLETE
Request Date: 2019-03-21	Status Date: 2019-03-21
Member Name: Natalia Gregory	Date of Birth: 2009-11-16
Employer ID: VAUGHAN	Member ID: 19855452302
Effective Date: 2019-03-01	SSN: 539673190
Gender: F	Submitted By: 332291
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3683	Status: COMPLETE
Request Date: 2019-03-21	Status Date: 2019-03-21
Member Name: Nathaniel Gregory	Date of Birth: 2016-10-08
Employer ID: VAUGHAN	Member ID: 19855452303
Effective Date: 2019-03-01	SSN: 046931184
Gender: M	Submitted By: 332291
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3727	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Bradley Nolan	Date of Birth: 1984-04-04
Employer ID: CAREOS	Member ID: 94862511201
Effective Date: 2019-03-01	SSN: 535989896
Gender: M	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: FLM101	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3727	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Leandra Woodward	Date of Birth: 2009-02-25
Employer ID: CAREOS	Member ID: 94862511202
Effective Date: 2019-03-01	SSN: 539659471
Gender: F	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: FLM101	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3727	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Killie Vest	Date of Birth: 2010-03-19
Employer ID: CAREOS	Member ID: 94862511203
Effective Date: 2019-03-01	SSN: 534691348
Gender: F	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: FLM101	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3727	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Braiden Nolan	Date of Birth: 2013-09-24
Employer ID: CAREOS	Member ID: 94862511204
Effective Date: 2019-03-01	SSN: 101493213
Gender: M	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: FLM101	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3735	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Bradley Nolan	Date of Birth: 1984-04-04
Employer ID: VAUGHAN	Member ID: 94862511201
Effective Date: 2019-03-01	SSN: 535989896
Gender: M	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3735	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Leandra Woodward	Date of Birth: 2009-02-25
Employer ID: VAUGHAN	Member ID: 94862511202
Effective Date: 2019-03-01	SSN: 539659471
Gender: F	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3735	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Killie Vest	Date of Birth: 2010-03-19
Employer ID: VAUGHAN	Member ID: 94862511203
Effective Date: 2019-03-01	SSN: 534691348
Gender: F	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3735	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Braiden Nolan	Date of Birth: 2013-09-24
Employer ID: VAUGHAN	Member ID: 94862511204
Effective Date: 2019-03-01	SSN: 101493213
Gender: M	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3742	Status: COMPLETE
Request Date: 2016-10-14	Status Date: 2016-10-14
Member Name: Magdalena Nava Justo	Date of Birth: 1984-12-28
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-07-01	SSN: 534875643
Gender: F	Submitted By: 48576
Mailing Address: 315 E Griffin Dr #15 Bozeman MT 59715	Home Address: 315 E Griffin Dr #15 Bozeman MT 59715
Phone Number: 4065812394	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3742	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Magdalena Nava Justo	Date of Birth: 1984-12-28
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-07-01	SSN: 534875643
Gender: F	Submitted By: 276683
Mailing Address: 315 E Griffin Dr #15 Bozeman MT 59715	Home Address: 315 E Griffin Dr #15 Bozeman MT 59715
Phone Number: 4065812394	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3742	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Magdalena Nava Justo	Date of Birth: 1984-12-28
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-07-01	SSN: 534875643
Gender: F	Submitted By: 276683
Mailing Address: 315 E Griffin Dr #15 Bozeman MT 59715	Home Address: 315 E Griffin Dr #15 Bozeman MT 59715
Phone Number: 4065812394	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: please mail to address: Michael Tillett, II 1817 Edgecombe Avenue Fayetteville, NC 28301

Request ID: 3742	Status: COMPLETE
Request Date: 2016-10-14	Status Date: 2016-10-14
Member Name: Magdalena Nava Justo	Date of Birth: 1984-12-28
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-07-01	SSN: 534875643
Gender: F	Submitted By: 48576
Mailing Address: 315 E Griffin Dr #15 Bozeman MT 59715	Home Address: 315 E Griffin Dr #15 Bozeman MT 59715
Phone Number: 4065812394	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: please mail to address: Michael Tillett, II 1817 Edgecombe Avenue Fayetteville, NC 28301

Request ID: 3762	Status: COMPLETE
Request Date: 2016-10-14	Status Date: 2016-10-14
Member Name: Primus D Ramirez	Date of Birth: 1994-05-28
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-06-01	SSN: 648033849
Gender: M	Submitted By: 48576
Mailing Address: 315 E. Griffin Drive, #11 Bozeman MT 59715	Home Address: 315 E. Griffin Drive, #11 Bozeman MT 59715
Phone Number: 4064046379	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3762	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Primus D Ramirez	Date of Birth: 1994-05-28
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-06-01	SSN: 648033849
Gender: M	Submitted By: 294404
Mailing Address: 315 E. Griffin Drive, #11 Bozeman MT 59715	Home Address: 315 E. Griffin Drive, #11 Bozeman MT 59715
Phone Number: 4064046379	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3762	Status: COMPLETE
Request Date: 2019-03-22	Status Date: 2019-03-22
Member Name: Primus D Ramirez	Date of Birth: 1994-05-28
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-06-01	SSN: 648033849
Gender: M	Submitted By: 294404
Mailing Address: 315 E. Griffin Drive, #11 Bozeman MT 59715	Home Address: 315 E. Griffin Drive, #11 Bozeman MT 59715
Phone Number: 4064046379	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3762	Status: COMPLETE
Request Date: 2016-10-14	Status Date: 2016-10-14
Member Name: Primus D Ramirez	Date of Birth: 1994-05-28
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-06-01	SSN: 648033849
Gender: M	Submitted By: 48576
Mailing Address: 315 E. Griffin Drive, #11 Bozeman MT 59715	Home Address: 315 E. Griffin Drive, #11 Bozeman MT 59715
Phone Number: 4064046379	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3782	Status: COMPLETE
Request Date: 2016-10-14	Status Date: 2016-10-14
Member Name: Primus D Ramirez	Date of Birth: 1994-05-28
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-06-01	SSN: 648033849
Gender: M	Submitted By: 48576
Mailing Address: 315 E. Griffin Drive, #11 Bozeman MT 59715	Home Address: 315 E. Griffin Drive, #11 Bozeman MT 59715
Phone Number: 4064046379	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3862	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: Kayln Brown	Date of Birth: 1996-06-18
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 300986581
Gender: F	Submitted By: 55914
Mailing Address: 1218 Wildrose Lane Neenah WI 54956	Home Address: 1218 Wildrose Lane Neenah WI 54956
Phone Number: 9202688635	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3862	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: Kayln Brown	Date of Birth: 1996-06-18
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 300986581
Gender: F	Submitted By: 294404
Mailing Address: 1218 Wildrose Lane Neenah WI 54956	Home Address: 1218 Wildrose Lane Neenah WI 54956
Phone Number: 9202688635	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3862	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: Kayln Brown	Date of Birth: 1996-06-18
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 300986581
Gender: F	Submitted By: 294404
Mailing Address: 1218 Wildrose Lane Neenah WI 54956	Home Address: 1218 Wildrose Lane Neenah WI 54956
Phone Number: 9202688635	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3862	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: Kayln Brown	Date of Birth: 1996-06-18
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 300986581
Gender: F	Submitted By: 55914
Mailing Address: 1218 Wildrose Lane Neenah WI 54956	Home Address: 1218 Wildrose Lane Neenah WI 54956
Phone Number: 9202688635	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3863	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: Austin Reed	Date of Birth: 1993-01-11
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 394111761
Gender: M	Submitted By: 294404
Mailing Address: 4100 N Gillett Street Appleton WI 54913	Home Address: 4100 N Gillett Street Appleton WI 54913
Phone Number: 9206362302	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3863	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: Austin Reed	Date of Birth: 1993-01-11
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 394111761
Gender: M	Submitted By: 55914
Mailing Address: 4100 N Gillett Street Appleton WI 54913	Home Address: 4100 N Gillett Street Appleton WI 54913
Phone Number: 9206362302	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3863	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: Austin Reed	Date of Birth: 1993-01-11
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 394111761
Gender: M	Submitted By: 55914
Mailing Address: 4100 N Gillett Street Appleton WI 54913	Home Address: 4100 N Gillett Street Appleton WI 54913
Phone Number: 9206362302	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 3863	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: Austin Reed	Date of Birth: 1993-01-11
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 394111761
Gender: M	Submitted By: 294404
Mailing Address: 4100 N Gillett Street Appleton WI 54913	Home Address: 4100 N Gillett Street Appleton WI 54913
Phone Number: 9206362302	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 3863	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 28852928201
Effective Date: 2016-10-01	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 1235 JERICHO RD POINT PLEASANT WV 25550
Phone Number:	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3863	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: null null null	Date of Birth: null
Employer ID: MGR	Member ID: 28852928201
Effective Date: 2016-10-01	SSN: null
Gender: U	Submitted By: 55914
Mailing Address: 1235 JERICHO RD POINT PLEASANT WV 25550
Phone Number:	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3863	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: null null null	Date of Birth: null
Employer ID: MGR	Member ID: 28852928201
Effective Date: 2016-10-01	SSN: null
Gender: U	Submitted By: 55914
Mailing Address: 1235 JERICHO RD POINT PLEASANT WV 25550
Phone Number:	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 3863	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 28852928201
Effective Date: 2016-10-01	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 1235 JERICHO RD POINT PLEASANT WV 25550
Phone Number:	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 3864	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: William Aney	Date of Birth: 1995-11-13
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 390152492
Gender: M	Submitted By: 55914
Mailing Address: 4208 53rd Street Kenosha WI 53144	Home Address: 4208 53rd Street Kenosha WI 53144
Phone Number: 2627480067	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3864	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: William Aney	Date of Birth: 1995-11-13
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 390152492
Gender: M	Submitted By: 294404
Mailing Address: 4208 53rd Street Kenosha WI 53144	Home Address: 4208 53rd Street Kenosha WI 53144
Phone Number: 2627480067	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3864	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: William Aney	Date of Birth: 1995-11-13
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 390152492
Gender: M	Submitted By: 294404
Mailing Address: 4208 53rd Street Kenosha WI 53144	Home Address: 4208 53rd Street Kenosha WI 53144
Phone Number: 2627480067	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3864	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: William Aney	Date of Birth: 1995-11-13
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 390152492
Gender: M	Submitted By: 55914
Mailing Address: 4208 53rd Street Kenosha WI 53144	Home Address: 4208 53rd Street Kenosha WI 53144
Phone Number: 2627480067	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3865	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: Timothy Langston	Date of Birth: 1990-04-16
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 393064890
Gender: M	Submitted By: 294404
Mailing Address: 703 N Division Street Appleton WI 54911	Home Address: 703 N Division Street Appleton WI 54911
Phone Number: 9203787624	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3865	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: Timothy Langston	Date of Birth: 1990-04-16
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 393064890
Gender: M	Submitted By: 55914
Mailing Address: 703 N Division Street Appleton WI 54911	Home Address: 703 N Division Street Appleton WI 54911
Phone Number: 9203787624	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3865	Status: COMPLETE
Request Date: 2016-10-17	Status Date: 2016-10-17
Member Name: Timothy Langston	Date of Birth: 1990-04-16
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 393064890
Gender: M	Submitted By: 55914
Mailing Address: 703 N Division Street Appleton WI 54911	Home Address: 703 N Division Street Appleton WI 54911
Phone Number: 9203787624	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3865	Status: COMPLETE
Request Date: 2019-03-25	Status Date: 2019-03-25
Member Name: Timothy Langston	Date of Birth: 1990-04-16
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 393064890
Gender: M	Submitted By: 294404
Mailing Address: 703 N Division Street Appleton WI 54911	Home Address: 703 N Division Street Appleton WI 54911
Phone Number: 9203787624	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3982	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Candice Wolfe	Date of Birth: 1974-09-13
Employer ID: null	Member ID: 2494701
Effective Date: 2016-11-01	SSN: 533041271
Gender: F	Submitted By: 294404
Mailing Address: PO Box 722 Orting WA 98360
Phone Number: 2538449054	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3982	Status: COMPLETE
Request Date: 2016-10-24	Status Date: 2016-10-24
Member Name: Candice Wolfe	Date of Birth: 1974-09-13
Employer ID: NESS	Member ID: 2494701
Effective Date: 2016-11-01	SSN: 533041271
Gender: F	Submitted By: 64974
Mailing Address: PO Box 722 Orting WA 98360
Phone Number: 2538449054	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3982	Status: COMPLETE
Request Date: 2016-10-24	Status Date: 2016-10-24
Member Name: Candice Wolfe	Date of Birth: 1974-09-13
Employer ID: NESS	Member ID: 2494701
Effective Date: 2016-11-01	SSN: 533041271
Gender: F	Submitted By: 64974
Mailing Address: PO Box 722 Orting WA 98360
Phone Number: 2538449054	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3982	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Candice Wolfe	Date of Birth: 1974-09-13
Employer ID: null	Member ID: 2494701
Effective Date: 2016-11-01	SSN: 533041271
Gender: F	Submitted By: 294404
Mailing Address: PO Box 722 Orting WA 98360
Phone Number: 2538449054	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3996	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Elizabeth Uzzell	Date of Birth: 1976-05-19
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 455453795
Gender: F	Submitted By: 335450
Mailing Address: 111 Pioneer St. Unit A SAFB TX 76311	Home Address: 111 Pioneer St. Unit A SAFB TX 76311
Phone Number: 9405384068	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3996	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Colby Titus	Date of Birth: 1996-02-13
Employer ID: CNT	Member ID: 12345678902
Effective Date: 2019-04-01	SSN: 635586166
Gender: M	Submitted By: 335450
Mailing Address: 111 Pioneer St. Unit A SAFB TX 76311
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3996	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Caleb Titus	Date of Birth: 1997-08-10
Employer ID: CNT	Member ID: 12345678903
Effective Date: 2019-04-01	SSN: 635520357
Gender: M	Submitted By: 335450
Mailing Address: 111 Pioneer St. Unit A SAFB TX 76311
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3996	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Sadie Uzzell	Date of Birth: 2008-10-11
Employer ID: CNT	Member ID: 12345678904
Effective Date: 2019-04-01	SSN: 637176884
Gender: F	Submitted By: 335450
Mailing Address: 111 Pioneer St. Unit A SAFB TX 76311
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3997	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Khay Williams	Date of Birth: 1984-02-28
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-04-01	SSN:
Gender: U	Submitted By: 335450
Mailing Address: 1716 Central Fwy Wichita Falls TX 76306	Home Address: 1716 Central Frwy Wichita Falls TX 76306
Phone Number: 9402525433	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3997	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Andrew Williams	Date of Birth: 1977-02-17
Employer ID: CNT	Member ID: 12345678903
Effective Date: 2019-04-01	SSN: 372826466
Gender: M	Submitted By: 335450
Mailing Address: 1716 Central Frwy Wichita Falls TX 76306
Phone Number:	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 3998	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Shannon Burleson	Date of Birth: 1968-11-03
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 467754025
Gender: F	Submitted By: 335450
Mailing Address: 11221 FM Road 1954 Wichita Falls TX 76310	Home Address: 11221 FM Road 1954 Wichita Falls TX 76310
Phone Number: 9407339954	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4002	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: David Robinson	Date of Birth: 1987-03-23
Employer ID: null	Member ID: 2494901
Effective Date: 2016-11-01	SSN: 534043535
Gender: M	Submitted By: 294404
Mailing Address: 25121 22nd Ave. S Kent WA 98032
Phone Number: 2066028306	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4002	Status: COMPLETE
Request Date: 2016-10-24	Status Date: 2016-10-24
Member Name: David Robinson	Date of Birth: 1987-03-23
Employer ID: NESS	Member ID: 2494901
Effective Date: 2016-11-01	SSN: 534043535
Gender: M	Submitted By: 64974
Mailing Address: 25121 22nd Ave. S Kent WA 98032
Phone Number: 2066028306	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4002	Status: COMPLETE
Request Date: 2016-10-24	Status Date: 2016-10-24
Member Name: David Robinson	Date of Birth: 1987-03-23
Employer ID: NESS	Member ID: 2494901
Effective Date: 2016-11-01	SSN: 534043535
Gender: M	Submitted By: 64974
Mailing Address: 25121 22nd Ave. S Kent WA 98032
Phone Number: 2066028306	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4002	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: David Robinson	Date of Birth: 1987-03-23
Employer ID: null	Member ID: 2494901
Effective Date: 2016-11-01	SSN: 534043535
Gender: M	Submitted By: 294404
Mailing Address: 25121 22nd Ave. S Kent WA 98032
Phone Number: 2066028306	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4024	Status: COMPLETE
Request Date: 2019-03-26	Status Date: 2019-03-26
Member Name: Lorien Reiff	Date of Birth: 1993-02-06
Employer ID: ALFALFA	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 242758132
Gender: F	Submitted By: 301138
Mailing Address: 4630 Macky Way Boulder CO 80305	Home Address: 4630 Macky Way Boulder CO 80305
Phone Number:	Email Address:
Selected Plan: AM0001	Medical: Yes Vision: No Dental: Yes D1
Comments:

Request ID: 4027	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: Fidel Flores	Date of Birth: 1979-09-28
Employer ID: OBI	Member ID: 72151702901
Effective Date: 2019-03-21	SSN: 107909435
Gender: M	Submitted By: 77174
Mailing Address: 38616 N Navarro Dr San Tan Valley AZ 85140	Home Address: 38616 N Navarro Dr San Tan Valley AZ 85140
Phone Number: 6026530661	Email Address:
Selected Plan: HD3208	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4027	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: Michelle Flores Fuentes	Date of Birth: 2019-03-21
Employer ID: OBI	Member ID: 72151702902
Effective Date: 2019-03-21	SSN: applied
Gender: F	Submitted By: 77174
Mailing Address: 38616 N Navarro Dr San Tan Valley AZ 85140
Phone Number:	Email Address:
Selected Plan: HD3208	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4042	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: Anderson Woods	Date of Birth: 1980-07-18
Employer ID: null	Member ID: 2499001
Effective Date: 2016-11-01	SSN: 560637438
Gender: M	Submitted By: 450806
Mailing Address: 3515 70th Ave. E. Apt. K302 Fife WA 98424
Phone Number: 3609695145	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4042	Status: COMPLETE
Request Date: 2016-10-24	Status Date: 2016-10-24
Member Name: Anderson Woods	Date of Birth: 1980-07-18
Employer ID: NESS	Member ID: 2499001
Effective Date: 2016-11-01	SSN: 560637438
Gender: M	Submitted By: 64974
Mailing Address: 3515 70th Ave. E. Apt. K302 Fife WA 98424
Phone Number: 3609695145	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4062	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: Kevin Jeffers	Date of Birth: 1993-05-02
Employer ID: null	Member ID: 2498201
Effective Date: 2016-11-01	SSN: 535296780
Gender: M	Submitted By: 301138
Mailing Address: 12630 SE 300th Way Auburn WA 98092
Phone Number: 2538864467	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4062	Status: COMPLETE
Request Date: 2016-10-24	Status Date: 2016-10-24
Member Name: Kevin Jeffers	Date of Birth: 1993-05-02
Employer ID: NESS	Member ID: 2498201
Effective Date: 2016-11-01	SSN: 535296780
Gender: M	Submitted By: 64974
Mailing Address: 12630 SE 300th Way Auburn WA 98092
Phone Number: 2538864467	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4062	Status: COMPLETE
Request Date: 2016-10-24	Status Date: 2016-10-24
Member Name: Kevin Jeffers	Date of Birth: 1993-05-02
Employer ID: NESS	Member ID: 2498201
Effective Date: 2016-11-01	SSN: 535296780
Gender: M	Submitted By: 64974
Mailing Address: 12630 SE 300th Way Auburn WA 98092
Phone Number: 2538864467	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4062	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: Kevin Jeffers	Date of Birth: 1993-05-02
Employer ID: null	Member ID: 2498201
Effective Date: 2016-11-01	SSN: 535296780
Gender: M	Submitted By: 301138
Mailing Address: 12630 SE 300th Way Auburn WA 98092
Phone Number: 2538864467	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4084	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: test test	Date of Birth: 1952-10-09
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 123456789
Gender: M	Submitted By: 333418
Mailing Address: test test AZ 85048
Phone Number: 4805558121	Email Address:
Selected Plan: MCS131	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4084	Status: COMPLETE
Request Date: 2016-10-26	Status Date: 2016-10-26
Member Name: test test	Date of Birth: 1952-10-09
Employer ID: NWP	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test AZ 85048
Phone Number: 4805558121	Email Address:
Selected Plan: MCS131	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4084	Status: COMPLETE
Request Date: 2016-10-26	Status Date: 2016-10-26
Member Name: test test	Date of Birth: 1952-10-09
Employer ID: NWP	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test AZ 85048
Phone Number: 4805558121	Email Address:
Selected Plan: MCS131	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP6 ID Cards

Request ID: 4084	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: test test	Date of Birth: 1952-10-09
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-10-01	SSN: 123456789
Gender: M	Submitted By: 333418
Mailing Address: test test AZ 85048
Phone Number: 4805558121	Email Address:
Selected Plan: MCS131	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP6 ID Cards

Request ID: 4085	Status: COMPLETE
Request Date: 2016-10-26	Status Date: 2016-10-26
Member Name: test test	Date of Birth: 2002-10-03
Employer ID: NWP	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test AZ 85048
Phone Number: 4805559871	Email Address:
Selected Plan: MCS131	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4085	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: test test	Date of Birth: 2002-10-03
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 123456789
Gender: M	Submitted By: 308152
Mailing Address: test test AZ 85048
Phone Number: 4805559871	Email Address:
Selected Plan: MCS131	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4085	Status: COMPLETE
Request Date: 2019-03-27	Status Date: 2019-03-27
Member Name: test test	Date of Birth: 2002-10-03
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 123456789
Gender: M	Submitted By: 308152
Mailing Address: test test AZ 85048
Phone Number: 4805559871	Email Address:
Selected Plan: MCS131	Medical: Yes Vision: No Dental: No
Comments: Member never received. Address verified.

Request ID: 4085	Status: COMPLETE
Request Date: 2016-10-26	Status Date: 2016-10-26
Member Name: test test	Date of Birth: 2002-10-03
Employer ID: NWP	Member ID: 12345678901
Effective Date: 2016-11-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test AZ 85048
Phone Number: 4805559871	Email Address:
Selected Plan: MCS131	Medical: Yes Vision: No Dental: No
Comments: Member never received. Address verified.

Request ID: 4124	Status: COMPLETE
Request Date: 2016-11-01	Status Date: 2016-11-01
Member Name: Anderson Woods	Date of Birth: 1980-07-18
Employer ID: NESS	Member ID: 2499001
Effective Date: 2016-12-01	SSN: 560637438
Gender: M	Submitted By: 64974
Mailing Address: 3515 70th Ave. E. Fife WA 98424
Phone Number: 3609695145	Email Address:
Selected Plan: MCS194	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4315	Status: COMPLETE
Request Date: 2019-03-28	Status Date: 2019-03-28
Member Name: Waranya Guthrie	Date of Birth: 1982-03-25
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 760888401
Gender: F	Submitted By: 333976
Mailing Address: 1801 E Katella Ave Apt 4014 Anaheim CA 92805	Home Address: 1801 E Katella Ave Apt 4014 Anaheim CA 92805
Phone Number: 7143911961	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 4315	Status: COMPLETE
Request Date: 2019-03-28	Status Date: 2019-03-28
Member Name: Michael Guthrie	Date of Birth: 1961-09-08
Employer ID: BURK	Member ID: 12345678902
Effective Date: 2019-04-01	SSN: 530620414
Gender: M	Submitted By: 333976
Mailing Address: 1801 E Katella Ave Apt 4014 Anaheim CA 92805
Phone Number: 7144827101	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 4385	Status: COMPLETE
Request Date: 2019-03-29	Status Date: 2019-03-29
Member Name: Ailill Stroh	Date of Birth: 1997-08-29
Employer ID: ALFALFA	Member ID: 12345678901
Effective Date: 2019-02-01	SSN: 649123292
Gender: M	Submitted By: 301138
Mailing Address: 212 West Pine St. Nederland CO 80466	Home Address: 212 West Pine St. Nederland CO 80466
Phone Number:	Email Address:
Selected Plan: AM0001	Medical: Yes Vision: No Dental: Yes D1
Comments:

Request ID: 4387	Status: COMPLETE
Request Date: 2019-03-29	Status Date: 2019-03-29
Member Name: Heather Collins	Date of Birth: 1997-08-21
Employer ID: ALFALFA	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 507232320
Gender: F	Submitted By: 301138
Mailing Address: 6750 East Chenango Ave #30 Denver CO 80237	Home Address: 6750 East Chenango Ave #30 Denver CO 80237
Phone Number:	Email Address:
Selected Plan: AM0001	Medical: Yes Vision: No Dental: Yes D1
Comments:

Request ID: 4388	Status: COMPLETE
Request Date: 2019-03-29	Status Date: 2019-03-29
Member Name: Elizabeth Del Valle Kumar	Date of Birth: 1986-01-19
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 626487856
Gender: F	Submitted By: 333976
Mailing Address: 11730 National Blvd Apt 5 Los Angeles CA 90064
Phone Number: 9496896558	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 4814	Status: COMPLETE
Request Date: 2019-04-02	Status Date: 2019-04-02
Member Name: daniel dreher	Date of Birth: 1982-08-16
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 536908062
Gender: M	Submitted By: 120043
Mailing Address: 3930 Kansas St San Diego CA 92104
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4815	Status: COMPLETE
Request Date: 2019-04-02	Status Date: 2019-04-02
Member Name: Brenden valdez	Date of Birth: 1992-12-08
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 524874923
Gender: M	Submitted By: 120043
Mailing Address: 2801 Main Street Apt #345 Irvine CA 92614
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 4983	Status: COMPLETE
Request Date: 2019-04-03	Status Date: 2019-04-03
Member Name: Julia Voth	Date of Birth: 1985-05-16
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 092964549
Gender: F	Submitted By: 333976
Mailing Address: 1840 Beverly Glen Blvd Los Angeles CA 90077	Home Address: 1840 Beverly Glen Blvd Los Angeles CA 90077
Phone Number: 8188590762	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 4984	Status: COMPLETE
Request Date: 2019-04-03	Status Date: 2019-04-03
Member Name: Jazmine Benton	Date of Birth: 1988-11-19
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 620188635
Gender: F	Submitted By: 333976
Mailing Address: 1939 W 65th St Los Angeles CA 90047	Home Address: 1939 W 65th St Los Angeles CA 90047
Phone Number: 3236327841	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 5040	Status: COMPLETE
Request Date: 2019-04-03	Status Date: 2019-04-03
Member Name: Jinzhao Chen	Date of Birth: 1987-06-07
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 610378072
Gender: M	Submitted By: 120043
Mailing Address: 14 Pope St San Francisco CA 94112
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5042	Status: COMPLETE
Request Date: 2016-11-28	Status Date: 2016-11-28
Member Name: Isabel Romero Romero	Date of Birth: 1981-07-06
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2016-12-01	SSN: 122859358
Gender: M	Submitted By: 63789
Mailing Address: 1135 Rose Place Othello WA 99344	Home Address: 1135 Rose Place Othello WA 99344
Phone Number: 5099131046	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5045	Status: COMPLETE
Request Date: 2019-04-03	Status Date: 2019-04-03
Member Name: mao mao	Date of Birth: 1995-04-06
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 759083537
Gender: F	Submitted By: 120043
Mailing Address: 325 CORONADO AVE DALY CITY CA 94015
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5046	Status: COMPLETE
Request Date: 2019-04-03	Status Date: 2019-04-03
Member Name: julio sapon	Date of Birth: 1985-08-13
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 449977614
Gender: M	Submitted By: 120043
Mailing Address: 2700 Jo Ann St Stafford TX 77477
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5048	Status: COMPLETE
Request Date: 2019-04-03	Status Date: 2019-04-03
Member Name: LEO RUELAS	Date of Birth: 1989-12-14
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 621305911
Gender: U	Submitted By: 120043
Mailing Address: 2114 Turtle Ln Mission TX 78572
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5149	Status: COMPLETE
Request Date: 2019-04-04	Status Date: 2019-04-04
Member Name: Antonia Franco	Date of Birth: 1991-11-15
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 606643117
Gender: F	Submitted By: 333976
Mailing Address: 11597 Bonham Ave Sylmar CA 91342	Home Address: 11597 Bonham Ave Sylmar CA 91342
Phone Number: 7472208668	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 5149	Status: COMPLETE
Request Date: 2019-04-04	Status Date: 2019-04-04
Member Name: Jianna Aubrielle Franco	Date of Birth: 2017-12-13
Employer ID: BURK	Member ID: 12345678902
Effective Date: 2019-04-01	SSN: 770450509
Gender: F	Submitted By: 333976
Mailing Address: 11597 Bonham Ave Sylmar CA 91342
Phone Number: 7472208668	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 5163	Status: COMPLETE
Request Date: 2019-04-05	Status Date: 2019-04-05
Member Name: JOshua Diaz	Date of Birth: 1995-06-24
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 634488369
Gender: M	Submitted By: 120043
Mailing Address: 202 Airline Rd Apt 1405 Corpus Christi TX 78412
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5181	Status: COMPLETE
Request Date: 2019-04-05	Status Date: 2019-04-05
Member Name: Jayson Burgher	Date of Birth: 1972-12-01
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 535807187
Gender: M	Submitted By: 332291
Mailing Address: 108 Hillcrest Drive Elma WA 98541	Home Address: 108 Hillcrest Drive Elma WA 98541
Phone Number: 3605563896	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5182	Status: COMPLETE
Request Date: 2019-04-05	Status Date: 2019-04-05
Member Name: Leonidas Salazar	Date of Birth: 1954-07-17
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 645908863
Gender: M	Submitted By: 120043
Mailing Address: 1374 SE Cedar Street #11 Hillsboro OR 97123	Home Address: 1374 SE Cedar Street #11 Hillsboro OR 97123
Phone Number: 5033179163	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5182	Status: COMPLETE
Request Date: 2016-12-06	Status Date: 2016-12-06
Member Name: Leonidas Salazar	Date of Birth: 1954-07-17
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 645908863
Gender: M	Submitted By: 56536
Mailing Address: 1374 SE Cedar Street #11 Hillsboro OR 97123	Home Address: 1374 SE Cedar Street #11 Hillsboro OR 97123
Phone Number: 5033179163	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5182	Status: COMPLETE
Request Date: 2016-12-06	Status Date: 2016-12-06
Member Name: Leonidas Salazar	Date of Birth: 1954-07-17
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 645908863
Gender: M	Submitted By: 56536
Mailing Address: 1374 SE Cedar Street #11 Hillsboro OR 97123	Home Address: 1374 SE Cedar Street #11 Hillsboro OR 97123
Phone Number: 5033179163	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5182	Status: COMPLETE
Request Date: 2019-04-05	Status Date: 2019-04-05
Member Name: Leonidas Salazar	Date of Birth: 1954-07-17
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 645908863
Gender: M	Submitted By: 120043
Mailing Address: 1374 SE Cedar Street #11 Hillsboro OR 97123	Home Address: 1374 SE Cedar Street #11 Hillsboro OR 97123
Phone Number: 5033179163	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5222	Status: COMPLETE
Request Date: 2019-04-08	Status Date: 2019-04-08
Member Name: Alma E Gutierrez Huerta	Date of Birth: 1971-12-21
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 677942748
Gender: F	Submitted By: 276683
Mailing Address: 808 Weaver Rd Warden WA 98857
Phone Number: 5093610002	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5222	Status: COMPLETE
Request Date: 2016-12-30	Status Date: 2016-12-30
Member Name: Alma E Gutierrez Huerta	Date of Birth: 1971-12-21
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 677942748
Gender: F	Submitted By: 63789
Mailing Address: 808 Weaver Rd Warden WA 98857
Phone Number: 5093610002	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5222	Status: COMPLETE
Request Date: 2016-12-30	Status Date: 2016-12-30
Member Name: Alma E Gutierrez Huerta	Date of Birth: 1971-12-21
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 677942748
Gender: F	Submitted By: 63789
Mailing Address: 808 Weaver Rd Warden WA 98857
Phone Number: 5093610002	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments: Updating my mailing address so I can request for new cards.

Request ID: 5222	Status: COMPLETE
Request Date: 2019-04-08	Status Date: 2019-04-08
Member Name: Alma E Gutierrez Huerta	Date of Birth: 1971-12-21
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 677942748
Gender: F	Submitted By: 276683
Mailing Address: 808 Weaver Rd Warden WA 98857
Phone Number: 5093610002	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments: Updating my mailing address so I can request for new cards.

Request ID: 5222	Status: COMPLETE
Request Date: 2019-04-08	Status Date: 2019-04-08
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 59742587901
Effective Date: 2017-01-01	SSN: null
Gender: U	Submitted By: 276683
Mailing Address: PO Box 997 Window Rock AZ 86515
Phone Number: 9285512196	Email Address: out.print(rs.getString(16));
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5222	Status: COMPLETE
Request Date: 2016-12-30	Status Date: 2016-12-30
Member Name: null null null	Date of Birth: null
Employer ID: BHR	Member ID: 59742587901
Effective Date: 2017-01-01	SSN: null
Gender: U	Submitted By: 63789
Mailing Address: PO Box 997 Window Rock AZ 86515
Phone Number: 9285512196	Email Address: out.print(rs.getString(16));
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5222	Status: COMPLETE
Request Date: 2016-12-30	Status Date: 2016-12-30
Member Name: null null null	Date of Birth: null
Employer ID: BHR	Member ID: 59742587901
Effective Date: 2017-01-01	SSN: null
Gender: U	Submitted By: 63789
Mailing Address: PO Box 997 Window Rock AZ 86515
Phone Number: 9285512196	Email Address: out.print(rs.getString(16));
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments: Updating my mailing address so I can request for new cards.

Request ID: 5222	Status: COMPLETE
Request Date: 2019-04-08	Status Date: 2019-04-08
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 59742587901
Effective Date: 2017-01-01	SSN: null
Gender: U	Submitted By: 276683
Mailing Address: PO Box 997 Window Rock AZ 86515
Phone Number: 9285512196	Email Address: out.print(rs.getString(16));
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments: Updating my mailing address so I can request for new cards.

Request ID: 5283	Status: COMPLETE
Request Date: 2017-01-06	Status Date: 2017-01-06
Member Name: Yurina Chavez De Perez	Date of Birth: 1984-08-23
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-01-06	SSN: 537713611
Gender: F	Submitted By: 63789
Mailing Address: PO Box 1168 Warden WA 98857
Phone Number: 5097073045	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5283	Status: COMPLETE
Request Date: 2019-04-08	Status Date: 2019-04-08
Member Name: Yurina Chavez De Perez	Date of Birth: 1984-08-23
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-06	SSN: 537713611
Gender: F	Submitted By: 49757
Mailing Address: PO Box 1168 Warden WA 98857
Phone Number: 5097073045	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5284	Status: COMPLETE
Request Date: 2019-04-08	Status Date: 2019-04-08
Member Name: Kyle A Peters	Date of Birth: 1994-12-19
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-06	SSN: 539314956
Gender: M	Submitted By: 463154
Mailing Address: 8952 Tinker Loop #A Moses Lake WA 98837
Phone Number: 5098599726	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5284	Status: COMPLETE
Request Date: 2017-01-06	Status Date: 2017-01-06
Member Name: Kyle A Peters	Date of Birth: 1994-12-19
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-01-06	SSN: 539314956
Gender: M	Submitted By: 63789
Mailing Address: 8952 Tinker Loop #A Moses Lake WA 98837
Phone Number: 5098599726	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5302	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: ERIN L MIDGLEY	Date of Birth: 1977-03-08
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 014601578
Gender: F	Submitted By: 333418
Mailing Address: 3111 BEAR CANYON RD, UNIT C BOZEMAN MT 59715	Home Address: 3111 BEAR CANYON RD, UNIT C BOZEMAN MT 59715
Phone Number: 4065487598	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5302	Status: COMPLETE
Request Date: 2017-01-10	Status Date: 2017-01-10
Member Name: ERIN L MIDGLEY	Date of Birth: 1977-03-08
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 014601578
Gender: F	Submitted By: 48576
Mailing Address: 3111 BEAR CANYON RD, UNIT C BOZEMAN MT 59715	Home Address: 3111 BEAR CANYON RD, UNIT C BOZEMAN MT 59715
Phone Number: 4065487598	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5302	Status: COMPLETE
Request Date: 2017-01-10	Status Date: 2017-01-10
Member Name: ERIN L MIDGLEY	Date of Birth: 1977-03-08
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 014601578
Gender: F	Submitted By: 48576
Mailing Address: 3111 BEAR CANYON RD, UNIT C BOZEMAN MT 59715	Home Address: 3111 BEAR CANYON RD, UNIT C BOZEMAN MT 59715
Phone Number: 4065487598	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP3 ID card

Request ID: 5302	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: ERIN L MIDGLEY	Date of Birth: 1977-03-08
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 014601578
Gender: F	Submitted By: 333418
Mailing Address: 3111 BEAR CANYON RD, UNIT C BOZEMAN MT 59715	Home Address: 3111 BEAR CANYON RD, UNIT C BOZEMAN MT 59715
Phone Number: 4065487598	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP3 ID card

Request ID: 5302	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: CLARKE P SULLIVAN	Date of Birth: 1972-04-30
Employer ID: null	Member ID: 12345678902
Effective Date: 2017-01-01	SSN: 517044448
Gender: M	Submitted By: 333418
Mailing Address: 3111 Bear Canyon Rd Unit C Bozeman MT 59715
Phone Number: 4065487598	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5302	Status: COMPLETE
Request Date: 2017-01-10	Status Date: 2017-01-10
Member Name: CLARKE P SULLIVAN	Date of Birth: 1972-04-30
Employer ID: GHLP	Member ID: 12345678902
Effective Date: 2017-01-01	SSN: 517044448
Gender: M	Submitted By: 48576
Mailing Address: 3111 Bear Canyon Rd Unit C Bozeman MT 59715
Phone Number: 4065487598	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5302	Status: COMPLETE
Request Date: 2017-01-10	Status Date: 2017-01-10
Member Name: CLARKE P SULLIVAN	Date of Birth: 1972-04-30
Employer ID: GHLP	Member ID: 12345678902
Effective Date: 2017-01-01	SSN: 517044448
Gender: M	Submitted By: 48576
Mailing Address: 3111 Bear Canyon Rd Unit C Bozeman MT 59715
Phone Number: 4065487598	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP3 ID card

Request ID: 5302	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: CLARKE P SULLIVAN	Date of Birth: 1972-04-30
Employer ID: null	Member ID: 12345678902
Effective Date: 2017-01-01	SSN: 517044448
Gender: M	Submitted By: 333418
Mailing Address: 3111 Bear Canyon Rd Unit C Bozeman MT 59715
Phone Number: 4065487598	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP3 ID card

Request ID: 5303	Status: COMPLETE
Request Date: 2017-01-11	Status Date: 2017-01-11
Member Name: Gavin L. Gould	Date of Birth: 1982-10-30
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 395941731
Gender: M	Submitted By: 55914
Mailing Address: 916 River Street Schofield WI 54476	Home Address: 916 River Street Schofield WI 54476
Phone Number: 8123634432	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5303	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: Gavin L. Gould	Date of Birth: 1982-10-30
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 395941731
Gender: M	Submitted By: 333418
Mailing Address: 916 River Street Schofield WI 54476	Home Address: 916 River Street Schofield WI 54476
Phone Number: 8123634432	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5303	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: Gavin L. Gould	Date of Birth: 1982-10-30
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 395941731
Gender: M	Submitted By: 333418
Mailing Address: 916 River Street Schofield WI 54476	Home Address: 916 River Street Schofield WI 54476
Phone Number: 8123634432	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP3 ID card

Request ID: 5303	Status: COMPLETE
Request Date: 2017-01-11	Status Date: 2017-01-11
Member Name: Gavin L. Gould	Date of Birth: 1982-10-30
Employer ID: MGR	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 395941731
Gender: M	Submitted By: 55914
Mailing Address: 916 River Street Schofield WI 54476	Home Address: 916 River Street Schofield WI 54476
Phone Number: 8123634432	Email Address:
Selected Plan: MCS148	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP3 ID card

Request ID: 5322	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: Steven D Powell	Date of Birth: 1962-07-15
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-12-01	SSN: 517862060
Gender: M	Submitted By: 333418
Mailing Address: 316 S 16th Ave, #8 Bozeman MT 59715	Home Address: 316 S 16th Ave, #8 Bozeman MT 59715
Phone Number: 4065798075	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5322	Status: COMPLETE
Request Date: 2017-01-20	Status Date: 2017-01-20
Member Name: Steven D Powell	Date of Birth: 1962-07-15
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-12-01	SSN: 517862060
Gender: M	Submitted By: 48576
Mailing Address: 316 S 16th Ave, #8 Bozeman MT 59715	Home Address: 316 S 16th Ave, #8 Bozeman MT 59715
Phone Number: 4065798075	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5322	Status: COMPLETE
Request Date: 2017-01-20	Status Date: 2017-01-20
Member Name: Steven D Powell	Date of Birth: 1962-07-15
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2016-12-01	SSN: 517862060
Gender: M	Submitted By: 48576
Mailing Address: 316 S 16th Ave, #8 Bozeman MT 59715	Home Address: 316 S 16th Ave, #8 Bozeman MT 59715
Phone Number: 4065798075	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP3 ID cards

Request ID: 5322	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: Steven D Powell	Date of Birth: 1962-07-15
Employer ID: null	Member ID: 12345678901
Effective Date: 2016-12-01	SSN: 517862060
Gender: M	Submitted By: 333418
Mailing Address: 316 S 16th Ave, #8 Bozeman MT 59715	Home Address: 316 S 16th Ave, #8 Bozeman MT 59715
Phone Number: 4065798075	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Member needs HSP3 ID cards

Request ID: 5342	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: Marlene Hernandez	Date of Birth: 1984-03-27
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 559792504
Gender: F	Submitted By: 294404
Mailing Address: 207 Showplace #B Belgrade MT 59714	Home Address: 207 Showplace #B Belgrade MT 59714
Phone Number: 4065396702	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5342	Status: COMPLETE
Request Date: 2017-01-24	Status Date: 2017-01-24
Member Name: Marlene Hernandez	Date of Birth: 1984-03-27
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 559792504
Gender: F	Submitted By: 48576
Mailing Address: 207 Showplace #B Belgrade MT 59714	Home Address: 207 Showplace #B Belgrade MT 59714
Phone Number: 4065396702	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5342	Status: COMPLETE
Request Date: 2017-01-24	Status Date: 2017-01-24
Member Name: Marlene Hernandez	Date of Birth: 1984-03-27
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 559792504
Gender: F	Submitted By: 48576
Mailing Address: 207 Showplace #B Belgrade MT 59714	Home Address: 207 Showplace #B Belgrade MT 59714
Phone Number: 4065396702	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5342	Status: COMPLETE
Request Date: 2019-04-09	Status Date: 2019-04-09
Member Name: Marlene Hernandez	Date of Birth: 1984-03-27
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 559792504
Gender: F	Submitted By: 294404
Mailing Address: 207 Showplace #B Belgrade MT 59714	Home Address: 207 Showplace #B Belgrade MT 59714
Phone Number: 4065396702	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5403	Status: COMPLETE
Request Date: 2019-04-10	Status Date: 2019-04-10
Member Name: Blanca Narrete	Date of Birth: 1976-11-26
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 534559438
Gender: F	Submitted By: 205201
Mailing Address: 1121 Doolittle Rd Moses Lake WA 98837
Phone Number: 5097703809	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5403	Status: COMPLETE
Request Date: 2017-01-28	Status Date: 2017-01-28
Member Name: Blanca Narrete	Date of Birth: 1976-11-26
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 534559438
Gender: F	Submitted By: 63789
Mailing Address: 1121 Doolittle Rd Moses Lake WA 98837
Phone Number: 5097703809	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5403	Status: COMPLETE
Request Date: 2017-01-28	Status Date: 2017-01-28
Member Name: Blanca Narrete	Date of Birth: 1976-11-26
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 534559438
Gender: F	Submitted By: 63789
Mailing Address: 1121 Doolittle Rd Moses Lake WA 98837
Phone Number: 5097703809	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5403	Status: COMPLETE
Request Date: 2019-04-10	Status Date: 2019-04-10
Member Name: Blanca Narrete	Date of Birth: 1976-11-26
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 534559438
Gender: F	Submitted By: 205201
Mailing Address: 1121 Doolittle Rd Moses Lake WA 98837
Phone Number: 5097703809	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5489	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: Daisha Rogers	Date of Birth: 1998-02-16
Employer ID: CALHOUN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 671017956
Gender: F	Submitted By: 346823
Home Address: 4659 Arlon park Ct ellenwood GA 30294
Phone Number:	Email Address:
Selected Plan: ZCP010	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5491	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: Adonus Dasher	Date of Birth: 1982-10-07
Employer ID: CALHOUN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 255437888
Gender: F	Submitted By: 346823
Home Address: 305 HIDDEN CREEK Warner Robins GA 31088
Phone Number:	Email Address:
Selected Plan: ZCP009	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5495	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: Fantasia Johnson	Date of Birth: 1995-09-25
Employer ID: CALHOUN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 260930969
Gender: F	Submitted By: 346823
Home Address: 140 Sunflower Lane Covington GA 30016
Phone Number:	Email Address:
Selected Plan: ZCP009	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5496	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: Andrea Bacino	Date of Birth: 1987-05-08
Employer ID: CALHOUN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 348826721
Gender: F	Submitted By: 346823
Home Address: 692 Allen Anderson Rd Cleveland GA 30528
Phone Number:	Email Address:
Selected Plan: ZCP009	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5522	Status: COMPLETE
Request Date: 2017-02-01	Status Date: 2017-02-01
Member Name: Patrick Lester	Date of Birth: 1962-12-10
Employer ID: TLG	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 312806438
Gender: M	Submitted By: 94124
Mailing Address: 1402 Old Asbury Rd Mount Airy NC 27030
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5522	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: Patrick Lester	Date of Birth: 1962-12-10
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 312806438
Gender: M	Submitted By: 294404
Mailing Address: 1402 Old Asbury Rd Mount Airy NC 27030
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5522	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: Patrick Lester	Date of Birth: 1962-12-10
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 312806438
Gender: M	Submitted By: 294404
Mailing Address: 1402 Old Asbury Rd Mount Airy NC 27030
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 5522	Status: COMPLETE
Request Date: 2017-02-01	Status Date: 2017-02-01
Member Name: Patrick Lester	Date of Birth: 1962-12-10
Employer ID: TLG	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 312806438
Gender: M	Submitted By: 94124
Mailing Address: 1402 Old Asbury Rd Mount Airy NC 27030
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 5522	Status: COMPLETE
Request Date: 2017-02-01	Status Date: 2017-02-01
Member Name: Lynne Lester	Date of Birth: 1954-09-02
Employer ID: TLG	Member ID: 12345678902
Effective Date: 2017-02-01	SSN: 335469209
Gender: F	Submitted By: 94124
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5522	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: Lynne Lester	Date of Birth: 1954-09-02
Employer ID: null	Member ID: 12345678902
Effective Date: 2017-02-01	SSN: 335469209
Gender: F	Submitted By: 294404
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5522	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: Lynne Lester	Date of Birth: 1954-09-02
Employer ID: null	Member ID: 12345678902
Effective Date: 2017-02-01	SSN: 335469209
Gender: F	Submitted By: 294404
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 5522	Status: COMPLETE
Request Date: 2017-02-01	Status Date: 2017-02-01
Member Name: Lynne Lester	Date of Birth: 1954-09-02
Employer ID: TLG	Member ID: 12345678902
Effective Date: 2017-02-01	SSN: 335469209
Gender: F	Submitted By: 94124
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 5522	Status: COMPLETE
Request Date: 2017-02-01	Status Date: 2017-02-01
Member Name: null null null	Date of Birth: null
Employer ID: TLG	Member ID: 94116322401
Effective Date: 2017-02-01	SSN: null
Gender: U	Submitted By: 94124
Mailing Address: 148 E HARTWELL LN PHILADELPHIA PA 19118
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5522	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 94116322401
Effective Date: 2017-02-01	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 148 E HARTWELL LN PHILADELPHIA PA 19118
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5522	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 94116322401
Effective Date: 2017-02-01	SSN: null
Gender: U	Submitted By: 294404
Mailing Address: 148 E HARTWELL LN PHILADELPHIA PA 19118
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 5522	Status: COMPLETE
Request Date: 2017-02-01	Status Date: 2017-02-01
Member Name: null null null	Date of Birth: null
Employer ID: TLG	Member ID: 94116322401
Effective Date: 2017-02-01	SSN: null
Gender: U	Submitted By: 94124
Mailing Address: 148 E HARTWELL LN PHILADELPHIA PA 19118
Phone Number:	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments: PLEASE RESEND ID CARDS

Request ID: 5534	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: test test test	Date of Birth: 2019-04-01
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test test AZ 85226	Home Address: test test test AZ 85226
Phone Number: 4802225555	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5537	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: test546 test test	Date of Birth: 2019-04-01
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test test AZ 85226	Home Address: test test test AZ 85226
Phone Number: 4802225555	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 5538	Status: COMPLETE
Request Date: 2019-04-12	Status Date: 2019-04-12
Member Name: test546 test test	Date of Birth: 2019-04-01
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test test AZ 85226	Home Address: test test test AZ 85226
Phone Number: 4802225555	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5582	Status: COMPLETE
Request Date: 2017-02-02	Status Date: 2017-02-02
Member Name: Kenneth Atkinson	Date of Birth: 1985-12-08
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 517062956
Gender: M	Submitted By: 48576
Mailing Address: 2220 W Main Street, #119 Bozeman MT 59718	Home Address: 2220 W Main Street, #119 Bozeman MT 59718
Phone Number: 4065956667	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5622	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: Maria De Los Angeles Lopez Munos	Date of Birth: 1997-08-11
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 640719810
Gender: M	Submitted By: 333418
Mailing Address: 2220 W Main #21 Bozeman MT 59718	Home Address: 2220 W Main #21 Bozeman MT 59718
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5622	Status: COMPLETE
Request Date: 2017-02-02	Status Date: 2017-02-02
Member Name: Maria De Los Angeles Lopez Munos	Date of Birth: 1997-08-11
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 640719810
Gender: M	Submitted By: 48576
Mailing Address: 2220 W Main #21 Bozeman MT 59718	Home Address: 2220 W Main #21 Bozeman MT 59718
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5622	Status: COMPLETE
Request Date: 2017-02-02	Status Date: 2017-02-02
Member Name: Maria De Los Angeles Lopez Munos	Date of Birth: 1997-08-11
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 640719810
Gender: M	Submitted By: 48576
Mailing Address: 2220 W Main #21 Bozeman MT 59718	Home Address: 2220 W Main #21 Bozeman MT 59718
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Please update address

Request ID: 5622	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: Maria De Los Angeles Lopez Munos	Date of Birth: 1997-08-11
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 640719810
Gender: M	Submitted By: 333418
Mailing Address: 2220 W Main #21 Bozeman MT 59718	Home Address: 2220 W Main #21 Bozeman MT 59718
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Please update address

Request ID: 5622	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 32218099001
Effective Date: 2017-02-01	SSN: null
Gender: U	Submitted By: 333418
Mailing Address: 76 Stanwick Ct Somerset NJ 08873-4911	Home Address: 76 Stanwick Ct Somerset NJ 08873-4911
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5622	Status: COMPLETE
Request Date: 2017-02-02	Status Date: 2017-02-02
Member Name: null null null	Date of Birth: null
Employer ID: GHLP	Member ID: 32218099001
Effective Date: 2017-02-01	SSN: null
Gender: U	Submitted By: 48576
Mailing Address: 76 Stanwick Ct Somerset NJ 08873-4911	Home Address: 76 Stanwick Ct Somerset NJ 08873-4911
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5622	Status: COMPLETE
Request Date: 2017-02-02	Status Date: 2017-02-02
Member Name: null null null	Date of Birth: null
Employer ID: GHLP	Member ID: 32218099001
Effective Date: 2017-02-01	SSN: null
Gender: U	Submitted By: 48576
Mailing Address: 76 Stanwick Ct Somerset NJ 08873-4911	Home Address: 76 Stanwick Ct Somerset NJ 08873-4911
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Please update address

Request ID: 5622	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: null null null	Date of Birth: null
Employer ID: null	Member ID: 32218099001
Effective Date: 2017-02-01	SSN: null
Gender: U	Submitted By: 333418
Mailing Address: 76 Stanwick Ct Somerset NJ 08873-4911	Home Address: 76 Stanwick Ct Somerset NJ 08873-4911
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments: Please update address

Request ID: 5624	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: Nicole Schram	Date of Birth: 1993-04-04
Employer ID: LAKEDISC	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 469279119
Gender: F	Submitted By: 289163
Mailing Address: 2379 53rd St east Inver Grove Heights MN 55076
Phone Number:	Email Address:
Selected Plan: PP3470	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5649	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: Moenicka Bowen	Date of Birth: 1995-07-27
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 573732000
Gender: F	Submitted By: 120043
Mailing Address: 458 Manawai St Apt #409 Kapolei HI 96707
Phone Number:	Email Address:
Selected Plan: MWP100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5650	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: Gary Mumin	Date of Birth: 1973-06-03
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 560437668
Gender: M	Submitted By: 120043
Mailing Address: 13268 Criolla Cir Eastvale CA 92880
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5651	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: Gary Mumin	Date of Birth: 1973-06-03
Employer ID: WIRE	Member ID: 12345678901
Effective Date: 2019-04-01	SSN:
Gender: M	Submitted By: 120043
Mailing Address: 13268 Criolla Cir Eastvale CA 92880
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5651	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: Tyler Mumin	Date of Birth: 2010-07-08
Employer ID: WIRE	Member ID: 12345678902
Effective Date: 2019-04-01	SSN: 111111111
Gender: M	Submitted By: 120043
Mailing Address: 13268 Criolla Cir Eastvale CA 92880
Phone Number:	Email Address:
Selected Plan: MWG100	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5662	Status: COMPLETE
Request Date: 2019-04-15	Status Date: 2019-04-15
Member Name: Margarita Rosales Espinoza	Date of Birth: 1979-12-27
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 024372766
Gender: F	Submitted By: 49757
Mailing Address: 2220 West Main Street #72 Bozeman MT 59718	Home Address: 2220 West Main Street #72 Bozeman MT 59718
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5662	Status: COMPLETE
Request Date: 2017-02-02	Status Date: 2017-02-02
Member Name: Margarita Rosales Espinoza	Date of Birth: 1979-12-27
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 024372766
Gender: F	Submitted By: 48576
Mailing Address: 2220 West Main Street #72 Bozeman MT 59718	Home Address: 2220 West Main Street #72 Bozeman MT 59718
Phone Number:	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5682	Status: COMPLETE
Request Date: 2017-02-02	Status Date: 2017-02-02
Member Name: Matthew J Romano	Date of Birth: 1967-03-08
Employer ID: GHLP	Member ID: 12345678901
Effective Date: 2017-01-01	SSN: 158742836
Gender: M	Submitted By: 48576
Mailing Address: 411 E Tamarack Bozeman MT 59715	Home Address: 411 E Tamarack Bozeman MT 59715
Phone Number: 4065953440	Email Address:
Selected Plan: MCS138	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5717	Status: COMPLETE
Request Date: 2019-04-16	Status Date: 2019-04-16
Member Name: Helen Kral	Date of Birth: 1976-02-06
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 559856238
Gender: F	Submitted By: 333976
Mailing Address: 1412 California St Apt 2 Huntington Beach CA 92648	Home Address: 1412 California St Apt 2 Huntington Beach CO 92648
Phone Number: 6573427272	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 5740	Status: COMPLETE
Request Date: 2019-04-16	Status Date: 2019-04-16
Member Name: test test	Date of Birth: 2019-04-01
Employer ID: VAUGHAN	Member ID: 77474468901
Effective Date: 2019-04-01	SSN: 123456789
Gender: U	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5740	Status: COMPLETE
Request Date: 2019-04-16	Status Date: 2019-04-16
Member Name: Robert Tobey	Date of Birth: 2019-04-01
Employer ID: VAUGHAN	Member ID: 77474468902
Effective Date: 2019-04-01	SSN: 123456789
Gender: U	Submitted By: 49757
Mailing Address: PO Box 422 Elma WA 12345
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5822	Status: COMPLETE
Request Date: 2019-04-17	Status Date: 2019-04-17
Member Name: Victor J Elmore	Date of Birth: 1975-11-07
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 534783505
Gender: M	Submitted By: 371461
Mailing Address: 1118 Doolittle Moses Lake WA 98837
Phone Number: 5099108098	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments: never received original package please resend id cards

Request ID: 5822	Status: COMPLETE
Request Date: 2019-04-17	Status Date: 2019-04-17
Member Name: Victor J Elmore	Date of Birth: 1975-11-07
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 534783505
Gender: M	Submitted By: 371461
Mailing Address: 1118 Doolittle Moses Lake WA 98837
Phone Number: 5099108098	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5822	Status: COMPLETE
Request Date: 2017-02-10	Status Date: 2017-02-10
Member Name: Victor J Elmore	Date of Birth: 1975-11-07
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 534783505
Gender: M	Submitted By: 63789
Mailing Address: 1118 Doolittle Moses Lake WA 98837
Phone Number: 5099108098	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5822	Status: COMPLETE
Request Date: 2017-02-10	Status Date: 2017-02-10
Member Name: Victor J Elmore	Date of Birth: 1975-11-07
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 534783505
Gender: M	Submitted By: 63789
Mailing Address: 1118 Doolittle Moses Lake WA 98837
Phone Number: 5099108098	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments: never received original package please resend id cards

Request ID: 5823	Status: COMPLETE
Request Date: 2019-04-17	Status Date: 2019-04-17
Member Name: Jose J Moreno	Date of Birth: 1991-06-13
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 622581625
Gender: M	Submitted By: 276683
Mailing Address: 8953 B-Tinker Loop Moses Lake WA 98837
Phone Number: 5093506566	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5823	Status: COMPLETE
Request Date: 2017-02-10	Status Date: 2017-02-10
Member Name: Jose J Moreno	Date of Birth: 1991-06-13
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 622581625
Gender: M	Submitted By: 63789
Mailing Address: 8953 B-Tinker Loop Moses Lake WA 98837
Phone Number: 5093506566	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5823	Status: COMPLETE
Request Date: 2017-02-10	Status Date: 2017-02-10
Member Name: Jose J Moreno	Date of Birth: 1991-06-13
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 622581625
Gender: M	Submitted By: 63789
Mailing Address: 8953 B-Tinker Loop Moses Lake WA 98837
Phone Number: 5093506566	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5823	Status: COMPLETE
Request Date: 2019-04-17	Status Date: 2019-04-17
Member Name: Jose J Moreno	Date of Birth: 1991-06-13
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 622581625
Gender: M	Submitted By: 276683
Mailing Address: 8953 B-Tinker Loop Moses Lake WA 98837
Phone Number: 5093506566	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5842	Status: COMPLETE
Request Date: 2019-04-17	Status Date: 2019-04-17
Member Name: Igor N Mironov	Date of Birth: 1988-01-29
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 008740114
Gender: M	Submitted By: 49757
Mailing Address: 9575 B Harris Rd NE Moses Lake WA 98837
Phone Number: 5094234532	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5842	Status: COMPLETE
Request Date: 2017-02-10	Status Date: 2017-02-10
Member Name: Igor N Mironov	Date of Birth: 1988-01-29
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 008740114
Gender: M	Submitted By: 63789
Mailing Address: 9575 B Harris Rd NE Moses Lake WA 98837
Phone Number: 5094234532	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5843	Status: COMPLETE
Request Date: 2019-04-17	Status Date: 2019-04-17
Member Name: Nelson Ortiz Nunez	Date of Birth: 1990-05-26
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 135900898
Gender: M	Submitted By: 49757
Mailing Address: P.O. Box 719 Moses Lake WA 98837
Phone Number: 5099893501	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5843	Status: COMPLETE
Request Date: 2017-02-10	Status Date: 2017-02-10
Member Name: Nelson Ortiz Nunez	Date of Birth: 1990-05-26
Employer ID: BHR	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 135900898
Gender: M	Submitted By: 63789
Mailing Address: P.O. Box 719 Moses Lake WA 98837
Phone Number: 5099893501	Email Address:
Selected Plan: MCS145	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5915	Status: COMPLETE
Request Date: 2019-04-18	Status Date: 2019-04-18
Member Name: Brain A Baltazar	Date of Birth: 1992-09-23
Employer ID: SDMT	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 603604949
Gender: M	Submitted By: 374422
Mailing Address: 3072 Vancouver Ave San Diego CA 92104
Phone Number: 6197299697	Email Address:
Selected Plan: YPM349	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5915	Status: COMPLETE
Request Date: 2019-04-18	Status Date: 2019-04-18
Member Name: Valeria Baltazar	Date of Birth: 1996-03-23
Employer ID: SDMT	Member ID: 12345678902
Effective Date: 2019-05-01	SSN: 089572980
Gender: F	Submitted By: 374422
Mailing Address: 3072 Vancouver Ave San Diego CA 92104
Phone Number:	Email Address:
Selected Plan: YPM349	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5983	Status: COMPLETE
Request Date: 2019-04-22	Status Date: 2019-04-22
Member Name: Test Test Test	Date of Birth: 2019-04-01
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test test AZ 85226	Home Address: test test test AZ 85226
Phone Number: 1234567788	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5984	Status: COMPLETE
Request Date: 2019-04-22	Status Date: 2019-04-22
Member Name: Test Test Test	Date of Birth: 2019-04-01
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test test AZ 85226
Phone Number: 1234567788	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5986	Status: COMPLETE
Request Date: 2019-04-22	Status Date: 2019-04-22
Member Name: Test Test Test	Date of Birth: 2019-04-01
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 123456789
Gender: M	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5987	Status: COMPLETE
Request Date: 2019-04-22	Status Date: 2019-04-22
Member Name: Test Test Test	Date of Birth: 2019-04-01
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 123456789
Gender: M	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 5988	Status: COMPLETE
Request Date: 2019-04-22	Status Date: 2019-04-22
Member Name: Test Test Test	Date of Birth: 2019-04-01
Employer ID: VAUGHAN	Member ID: 12345678901
Effective Date: 2019-04-01	SSN:
Gender: M	Submitted By: 49757
Phone Number:	Email Address:
Selected Plan: ZCP004	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6162	Status: COMPLETE
Request Date: 2017-02-23	Status Date: 2017-02-23
Member Name: test test test	Date of Birth: 2017-02-01
Employer ID: OBI	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 123456789
Gender: M	Submitted By: 49757
Mailing Address: test test test AZ 85226	Home Address: test test test AZ 85667
Phone Number: 4805556718	Email Address:
Selected Plan: HD3208	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6163	Status: COMPLETE
Request Date: 2017-02-23	Status Date: 2017-02-23
Member Name: Martie Roberts	Date of Birth: 1994-01-03
Employer ID: FDF	Member ID: 12345678901
Effective Date: 2017-04-01	SSN: 231695505
Gender: M	Submitted By: 94124
Mailing Address: 1023 Newton Farm Rd South Boston VA 24592
Phone Number:	Email Address:
Selected Plan: MCS223	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6164	Status: COMPLETE
Request Date: 2017-02-23	Status Date: 2017-02-23
Member Name: Morgan King	Date of Birth: 1994-11-18
Employer ID: CORNER	Member ID: 12345678901
Effective Date: 2017-03-01	SSN: 630461972
Gender: F	Submitted By: 93080
Mailing Address: 701 N. Indiana Ave. Apt. 122 Lubbock TX 79415	Home Address: 701 N. Indiana Ave. Apt. 122 Lubbock TX 79415
Phone Number: 8062390327	Email Address:
Selected Plan: PP1226	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6165	Status: COMPLETE
Request Date: 2017-02-23	Status Date: 2017-02-23
Member Name: Morgan King	Date of Birth: 1994-11-18
Employer ID: CORNER	Member ID: 12345678901
Effective Date: 2017-03-01	SSN: 630461972
Gender: F	Submitted By: 93080
Mailing Address: 701 N. Indiana Ave. Apt. 122 Lubbock TX 79415	Home Address: 701 N. Indiana Ave. Apt. 122 Lubbock TX 79415
Phone Number: 8062390327	Email Address:
Selected Plan: PP1226	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6169	Status: COMPLETE
Request Date: 2017-02-24	Status Date: 2017-02-24
Member Name: Emelia Lopez Sixto	Date of Birth: 1966-11-08
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 638803472
Gender: F	Submitted By: 56536
Mailing Address: 100 Gatch St. Apt#20 Woodburn OR 97071
Phone Number:	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6202	Status: COMPLETE
Request Date: 2017-02-24	Status Date: 2017-02-24
Member Name: Filadelfo Lopez	Date of Birth: 1980-03-10
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2017-03-01	SSN: 619775888
Gender: M	Submitted By: 56536
Mailing Address: 1274 5th Street #9C Woodburn OR 97071
Phone Number: 5037543496	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6222	Status: COMPLETE
Request Date: 2017-02-24	Status Date: 2017-02-24
Member Name: Victor Martinez-Cortez	Date of Birth: 1980-02-07
Employer ID: ENF	Member ID: 12345678901
Effective Date: 2017-03-01	SSN: 544926676
Gender: M	Submitted By: 56536
Mailing Address: 182 NE Jackson #6 Hillsboro OR 97124
Phone Number: 5038582293	Email Address:
Selected Plan: MCS179	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6242	Status: COMPLETE
Request Date: 2017-02-24	Status Date: 2017-02-24
Member Name: Victorino Juarez	Date of Birth: 1982-11-12
Employer ID: CORNER	Member ID: 12345678901
Effective Date: 2017-03-01	SSN: 455633742
Gender: M	Submitted By: 93080
Mailing Address: 212 S. Ave. F Post TX 79356	Home Address: 212 S. Ave. F Post TX 79356
Phone Number: 8065434064	Email Address:
Selected Plan: PP1226	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6242	Status: COMPLETE
Request Date: 2017-02-24	Status Date: 2017-02-24
Member Name: Fabian Torres	Date of Birth: 1994-06-21
Employer ID: CORNER	Member ID: 12345678902
Effective Date: 2017-03-01	SSN: 636423811
Gender: M	Submitted By: 93080
Mailing Address: 212 S. Ave. F Post TX 79356
Phone Number:	Email Address:
Selected Plan: PP1226	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6242	Status: COMPLETE
Request Date: 2017-02-24	Status Date: 2017-02-24
Member Name: Brianna Casillas	Date of Birth: 2000-08-09
Employer ID: CORNER	Member ID: 12345678903
Effective Date: 2017-03-01	SSN: 637725636
Gender: F	Submitted By: 93080
Mailing Address: 212 S. Ave. F Post TX 79356
Phone Number:	Email Address:
Selected Plan: PP1226	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6242	Status: COMPLETE
Request Date: 2017-02-24	Status Date: 2017-02-24
Member Name: Victoria Juarez	Date of Birth: 2009-08-21
Employer ID: CORNER	Member ID: 12345678904
Effective Date: 2017-03-01	SSN: 642219007
Gender: F	Submitted By: 93080
Mailing Address: 212 S. Ave. F Post TX 79356
Phone Number:	Email Address:
Selected Plan: PP1226	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6289	Status: COMPLETE
Request Date: 2019-04-23	Status Date: 2019-04-23
Member Name: Rachel Heinle	Date of Birth: 1985-09-16
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 617242521
Gender: F	Submitted By: 333976
Mailing Address: 34032 Cambridge Rd Dana Point CA 92629	Home Address: 34032 Cambridge Rd Dana Point CA 92629
Phone Number: 7606952987	Email Address:
Selected Plan: CP4371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6319	Status: COMPLETE
Request Date: 2019-04-23	Status Date: 2019-04-23
Member Name: Janna Foley	Date of Birth: 1979-11-09
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 243411060
Gender: F	Submitted By: 294404
Mailing Address: 111 West Blue Ridge St Stuart VA 24171
Phone Number: 2766925176	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6319	Status: COMPLETE
Request Date: 2017-02-27	Status Date: 2017-02-27
Member Name: Janna Foley	Date of Birth: 1979-11-09
Employer ID: TLG	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 243411060
Gender: F	Submitted By: 94124
Mailing Address: 111 West Blue Ridge St Stuart VA 24171
Phone Number: 2766925176	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6319	Status: COMPLETE
Request Date: 2017-02-27	Status Date: 2017-02-27
Member Name: Janna Foley	Date of Birth: 1979-11-09
Employer ID: TLG	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 243411060
Gender: F	Submitted By: 94124
Mailing Address: 111 West Blue Ridge St Stuart VA 24171
Phone Number: 2766925176	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6319	Status: COMPLETE
Request Date: 2019-04-23	Status Date: 2019-04-23
Member Name: Janna Foley	Date of Birth: 1979-11-09
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 243411060
Gender: F	Submitted By: 294404
Mailing Address: 111 West Blue Ridge St Stuart VA 24171
Phone Number: 2766925176	Email Address:
Selected Plan: EMC225	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6604	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Nicholas Vonesh	Date of Birth: 1990-10-16
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-03-23	SSN: 227599598
Gender: M	Submitted By: 294404
Mailing Address: 1753 S Carr Street Lakewood CO 80232	Home Address: 1753 S Carr Street Lakewood CO 80232
Phone Number:	Email Address:
Selected Plan: PL5255	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6604	Status: COMPLETE
Request Date: 2017-03-06	Status Date: 2017-03-06
Member Name: Nicholas Vonesh	Date of Birth: 1990-10-16
Employer ID: YETI	Member ID: 12345678901
Effective Date: 2017-03-23	SSN: 227599598
Gender: M	Submitted By: 94202
Mailing Address: 1753 S Carr Street Lakewood CO 80232	Home Address: 1753 S Carr Street Lakewood CO 80232
Phone Number:	Email Address:
Selected Plan: PL5255	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6604	Status: COMPLETE
Request Date: 2017-03-06	Status Date: 2017-03-06
Member Name: Nicholas Vonesh	Date of Birth: 1990-10-16
Employer ID: YETI	Member ID: 12345678901
Effective Date: 2017-03-23	SSN: 227599598
Gender: M	Submitted By: 94202
Mailing Address: 1753 S Carr Street Lakewood CO 80232	Home Address: 1753 S Carr Street Lakewood CO 80232
Phone Number:	Email Address:
Selected Plan: PL5255	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6604	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Nicholas Vonesh	Date of Birth: 1990-10-16
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-03-23	SSN: 227599598
Gender: M	Submitted By: 294404
Mailing Address: 1753 S Carr Street Lakewood CO 80232	Home Address: 1753 S Carr Street Lakewood CO 80232
Phone Number:	Email Address:
Selected Plan: PL5255	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6607	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Christopher L Meiner	Date of Birth: 1979-11-24
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 526815407
Gender: U	Submitted By: 294404
Mailing Address: 32025 W Marsh Rd Casa Grande AZ 85193	Home Address: 32025 W Marsh Rd Casa Grande AZ 85193
Phone Number: 5207051139	Email Address:
Selected Plan: HD3208	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6607	Status: COMPLETE
Request Date: 2017-03-07	Status Date: 2017-03-07
Member Name: Christopher L Meiner	Date of Birth: 1979-11-24
Employer ID: OBI	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 526815407
Gender: U	Submitted By: 77174
Mailing Address: 32025 W Marsh Rd Casa Grande AZ 85193	Home Address: 32025 W Marsh Rd Casa Grande AZ 85193
Phone Number: 5207051139	Email Address:
Selected Plan: HD3208	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6607	Status: COMPLETE
Request Date: 2017-03-07	Status Date: 2017-03-07
Member Name: Christopher L Meiner	Date of Birth: 1979-11-24
Employer ID: OBI	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 526815407
Gender: U	Submitted By: 77174
Mailing Address: 32025 W Marsh Rd Casa Grande AZ 85193	Home Address: 32025 W Marsh Rd Casa Grande AZ 85193
Phone Number: 5207051139	Email Address:
Selected Plan: HD3208	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6607	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Christopher L Meiner	Date of Birth: 1979-11-24
Employer ID: null	Member ID: 12345678901
Effective Date: 2017-02-01	SSN: 526815407
Gender: U	Submitted By: 294404
Mailing Address: 32025 W Marsh Rd Casa Grande AZ 85193	Home Address: 32025 W Marsh Rd Casa Grande AZ 85193
Phone Number: 5207051139	Email Address:
Selected Plan: HD3208	Medical: Yes Vision: No Dental: No
Comments:

Request ID: 6622	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Iso Nakasato	Date of Birth: 1982-02-25
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 567734940
Gender: F	Submitted By: 333976
Mailing Address: 10142 Layrrylyn Dr Whittier CA 90603	Home Address: 10142 Layrrylyn Dr Whittier CA 90603
Phone Number: 6262016507	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6622	Status: COMPLETE
Request Date: 2017-03-07	Status Date: 2017-03-07
Member Name: Iso Nakasato	Date of Birth: 1982-02-25
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 567734940
Gender: F	Submitted By: 94124
Mailing Address: 10142 Layrrylyn Dr Whittier CA 90603	Home Address: 10142 Layrrylyn Dr Whittier CA 90603
Phone Number: 6262016507	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6622	Status: COMPLETE
Request Date: 2017-03-07	Status Date: 2017-03-07
Member Name: Iso Nakasato	Date of Birth: 1982-02-25
Employer ID: null	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 567734940
Gender: F	Submitted By: 94124
Mailing Address: 10142 Layrrylyn Dr Whittier CA 90603	Home Address: 10142 Layrrylyn Dr Whittier CA 90603
Phone Number: 6262016507	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6622	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Iso Nakasato	Date of Birth: 1982-02-25
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 567734940
Gender: F	Submitted By: 333976
Mailing Address: 10142 Layrrylyn Dr Whittier CA 90603	Home Address: 10142 Layrrylyn Dr Whittier CA 90603
Phone Number: 6262016507	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6623	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Bree Harsh	Date of Birth: 1986-05-06
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 562930390
Gender: F	Submitted By: 333976
Mailing Address: 2120 South State College Blvd Anaheim CA 92806	Home Address: 2120 South State College Blvd Anaheim CA 92806
Phone Number: 9493007393	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6624	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Roxanne Tan	Date of Birth: 1984-09-24
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 607745954
Gender: F	Submitted By: 333976
Mailing Address: 804 19th Ave Apt 12 San Mateo CA 94403	Home Address: 804 19th Ave Apt 12 San Mateo CA 94403
Phone Number: 6502181627	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6630	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Ashley Vetere	Date of Birth: 1988-06-08
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 219271789
Gender: F	Submitted By: 333976
Mailing Address: 11075 Shoshone Ave Granada Hills CA 91344	Home Address: 11075 Shoshone Ave Granada Hills CA 91344
Phone Number: 8186160053	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6631	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Tanyaratt Phiwphuak	Date of Birth: 1960-03-07
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 625828276
Gender: F	Submitted By: 333976
Mailing Address: 7901 Ventura Canyon Ave Apt 2 Panorama City CA 91402	Home Address: 7901 Ventura Canyon Ave Apt 2 Panorama City CA 91402
Phone Number: 6262221665	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6632	Status: COMPLETE
Request Date: 2019-04-26	Status Date: 2019-04-26
Member Name: Lindsey Porter	Date of Birth: 1982-04-02
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 220178247
Gender: F	Submitted By: 333976
Mailing Address: 26941 La Alameda Apt 4106 Mission Viejo CA 92691	Home Address: 26941 La Alameda Apt 4106 Mission Viejo CA 92691
Phone Number: 9513157676	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6713	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Kassandra Nelson	Date of Birth: 1982-09-14
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 626245536
Gender: F	Submitted By: 333976
Mailing Address: 6411 Merlin Drive Riverside CA 92506	Home Address: 6411 Merlin Drive Riverside CA 92506
Phone Number: 9512419882	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6717	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Sean Vanger	Date of Birth: 1973-01-24
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 617320612
Gender: M	Submitted By: 333976
Mailing Address: 8943 Chimineas Ave Northridge CA 91325	Home Address: 8943 Chimineas Ave Northridge CA 91325
Phone Number: 3107458053	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6719	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Joshua Geere	Date of Birth: 1991-11-11
Employer ID: BURK	Member ID: 98756117101
Effective Date: 2019-04-01	SSN: 607808744
Gender: M	Submitted By: 333976
Mailing Address: 13964 Ramhurst Dr Apt 15 La Mirada CA 90638	Home Address: 13964 Ramhurst Dr Apt 15 La Mirada CA 90638
Phone Number: 5623102501	Email Address:
Selected Plan: CP4371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6719	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Mia Geere	Date of Birth: 1997-05-07
Employer ID: BURK	Member ID: 98756117102
Effective Date: 2019-04-01	SSN: 415790857
Gender: F	Submitted By: 333976
Mailing Address: 13964 Ramhurst Dr Apt 15 La Mirada CA 90638
Phone Number: 5623102501	Email Address:
Selected Plan: CP4371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6724	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Melissa Schmidt	Date of Birth: 1991-01-14
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-04-01	SSN: 606642200
Gender: F	Submitted By: 333976
Mailing Address: 12748 Dean Pl Granada Hills CA 91344	Home Address: 12748 Dean Pl Granada Hills CA 91344
Phone Number: 8183630696	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6727	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Amanda Schumacher	Date of Birth: 1990-07-17
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 324868704
Gender: F	Submitted By: 333976
Mailing Address: 10701 S Eastern Ave Apt 2323 Henderson NV 89052	Home Address: 10701 S Eastern Ave Apt 2323 Henderson NV 89052
Phone Number: 8477789169	Email Address:
Selected Plan: CPR371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6728	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Tyler Naegle	Date of Birth: 1992-04-17
Employer ID: BURK	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 530673104
Gender: M	Submitted By: 333976
Mailing Address: 1770 Black Fox Canyon Rd Henderson NV 89052	Home Address: 1770 Black Fox Canyon Rd Henderson NV 89052
Phone Number: 7023552758	Email Address:
Selected Plan: CP2371	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6730	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Carlos Canez Villa	Date of Birth: 1988-11-27
Employer ID: SDMT	Member ID: 12345678901
Effective Date: 2019-05-01	SSN: 622667768
Gender: M	Submitted By: 374437
Mailing Address: 8085 Caminito de Pizza Unit E San Diego CA 92108
Phone Number: 7609601158	Email Address:
Selected Plan: YE2349	Medical: Yes Vision: Yes V1 Dental: No
Comments:

Request ID: 6731	Status: COMPLETE
Request Date: 2019-04-29	Status Date: 2019-04-29
Member Name: Brittany Duncan	Date of Birth: 1993-06-28
Employer ID: CNT	Member ID: 12345678901
Effective Date: 2019-04-26	SSN: 641440296
Gender: F	Submitted By: 335450
Mailing Address: 2505 Crescent Dr. Vernon TX 76384
Phone Number: 9408397979	Email Address:
Selected Plan: CTP100	Medical: Yes Vision: No Dental: Yes D0
Comments:

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Request ID: 6732	Status: COMPLETE