Filing a Medical Claim

If you visit a network provider, your provider should accept assignment of benefitsRefers to giving a provider permission to submit claims (evidence of loss) for medical services to the appropriate Claims Administrator for processing. Benefits may be assigned automatically to network providers based on their agreement with the plan's network. Benefits may also be assigned to a non-network provider if he/she allows it..  This means that all network doctors (and some non-network doctors) will submit your claim to the Health Fund on your behalf and the Health Fund will reimburse your doctor directly.  In some cases, a non-network provider will not accept assignment of benefits and will require you to pay your entire claim up-front.  It is important that you mail your claims to the appropriate address detailed in the links below. Claims that are incorrectly sent to the incorrect office may be returned or denied.

Each year, a Coordination of BenefitsThe payment of health care benefits when a member is covered by two or more benefit plans. One of the health plans will be primary and the other secondary. The primary plan pays first following its rules and schedule of benefits; then the payments under the secondary plan are coordinated so that combined plan payments don't exceed 100% of coinsurance. form is mailed to each participant during their open enrollment period to confirm if other insurance information exists.  If you have already filled out the Coordination of Benefits form for the current year and the information on the form has not changed, you do not need to re-submit this form to the Health Fund.  Otherwise, you will need to fill out the form and submit it to the Health Fund with your claim. The form is available here:

• Coordination of Benefits Form

For detailed instructions on filing a medical claim with the Health Fund, Bluecard/Anthem Blue Cross, Delta Dental or Behaviorial Health Claims, please click on the type of claim that you will be submitting for reimbursement:

Behavioral Health Claims Incurred After 12/31/2011

• Foreign Claims
• Hospital Claims
• Professional Claims (e.g. a doctor's visit)

Behavioral Health Claims Incurred Before 1/1/2012

• Behavioral Health Claims

Medical Claims

• Dental Claims
• Foreign Claims
• Hospital Claims
• Professional Claims (e.g. a doctor's visit)
• Vision Claims
• Wellness Claims (e.g. flu shots, smoking cessation programs, etc.)