The company office or person to contact about coverage is:

Address:

The University of Scranton, Human Resources Dept.
Linden and Monroe Avenue
Scranton, Pa 18510-4679

Phone:

(570) 941-7767

The appropriate Blue Cross and Blue Shield Plan contact is:

Address:

Blue Cross of Northeastern Pa.
70 North Main Street
Wilkes Barre, Pa 18711

Customer Service Phone:

1-800-829-8599

Website:

www.bluecares.com

Prescription Drugs:

1-877-603-8399

The Subscriber Number shown on my Identification Card is:

The Group Number shown on my Identification Card is:

The "Effective Date" when my coverage begins is: