PRIMARY-

Insurance Company: Aetna
Group Number: 237590-039-00001
ID Number: W2912 29304 Personal Number (if needed) 02
Active Date: January 1, 2025 – Present
Subscriber: Lyvonne Madeline Michelle Avery
Date of Birth: December 3, 1987
Relation: Spouse

SECONDARY/IF APPROVED-

(ONLY IF approved through VA Community Care, Emergency Care, or Hospital Admission)
VA Community Care Authorization (usually billed through TriWest (NOT the same as
TriCare))
Member ID: 542179779