TEMPORARY
IDENTIFICATION CARD
Student Accident and Sickness Insurance
Policy Fully Insured by Nationwide Life Insurance Company
Administered by: Student Assurance Services, Inc.
P.O. Box 196 • Stillwater, MN 55082-0196 • Phone (651) 439-7098
Covered Student: ___________________________________________
Student Identification Number: ________________________________
College/University Name: ____________________________________
PPO Customer Service: 800-279-9776
www.healtheos.com
Making a Claim or for More Information
Refer to the online brochure on the website:
www.sas-mn.com
Using a temporary ID card is not a guarantee of benefits
or confirmation of coverage under the plan. Benefits will
be evaluated when a claim is submitted for payment.
FORM NW2013-Temporary Website