UnitedHealthcare Insurance Company P.O. BOX 30655 Salt Lake City, UT 134130-0555 254CEISAA1002001-07467-01 STUART I ORSHER 9 EAST 71ST STREET NEWYORK NY 10021 September 9, 2017

who misuse information any be subject to both civil and criminal penalties. EFTA00283887 Fax Server 8/6/2014 2:17:38 PM PAGE 2/002 Fax Server UnitedHealthcare Insurance Company Initectifeakheare JEFFREY EPSTEIN 6100 RED HOOK QUARTER B-3 ST THOMAS VI 00802 Patient: Ref St: Member. • •••••• .• Member ID: Group: Gro

rs first. You will be responsible for paying your copayment and any additional amount, as required by the provisions of your pharmacy benefit. Your UnitedHealthcare Insurance Company prescription drug program is administered by OptumRx. For certain drugs, more information is needed to determine coverage eligibility. In these case

rs first. You will be responsible for paying your copayment and any additional amount, as required by the provisions of your pharmacy benefit. Your UnitedHealthcare Insurance Company prescription drug program is administered by OptumRx. For certain drugs, more information is needed to determine coverage eligibility. In these case