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Employee Details

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Name

John Fergusson

Social Security Number

619-76-3819

Gender

Male

Date of Birth

12/12/1825

Address

3410 Club Dr, Los Angeles, CA 90064

Phone Number

310-764-9819

Email Address

jfergusson@wordandbrown.com

Job Information

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Employment Status

Full-time

Occupation

User Experience Designer

Date of Hire

03/11/2013

Date of Full Time Employment

03/11/2013

Date Waiting Period Begins

28/12/2015

Working Hours per Week

40

Preffered Language

English

Does Member Read and Write in English?

Yes

Household Information

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Household Makeup

Family

Spouse

Jane Walles

Social Security Number

617-24-5636

Gender

Female

Date of Birth

28/12/1995

Addresss

Same as Empoyee

Child 1

Christian Walles

Social Security Number

65-24-5736

Gender

Male

Date of Birth

28/12/2015

Addresss

Same as Empoyee

Medical Plan

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Anthem Medical HMO Plan Name

Member Enrolled PCP PCP ID Existing Patient City State Zip
John Williams Enrolled Adan Clark 6184770 Yes Los Angeles California 90064
Gregory Williams Enrolled Adan Clark 6184770 Yes Los Angeles California 90064
Hunter Williams Enrolled Mathew Rid 2104560 No Los Angeles California 90064

Dental Plan

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Dental HMO Plan Name

Member Enrolled PDO PDO # Existing Patient City State Zip
John Williams Enrolled Office Name 6184770 Yes Los Angeles California 90064
Gregory Williams Enrolled Office Name 6184770 Yes Los Angeles California 90064
Hunter Williams Waived

Vision Plan

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Vision HMO Plan Name

Member PDO PDO # Existing Patient City State Zip Enrolled
John Williams
Gregory Williams
Hunter Williams

Life Plan

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Life HMO Plan Name

Member PDO PDO # Existing Patient City State Zip Enrolled
John Williams
Gregory Williams
Hunter Williams