How To File A Claim

Most health care providers bill the Trust Office directly. The Trust Office processes the claim and then provides an Explanation of Benefits (EOB) describing what this plan paid, the PPO discount, if applicable, and what is owed as part of the annual deductible, copayment, coinsurance, and noncovered expenses.

If services or supplies are received from a provider that does not bill the Trust Office directly, or if the individual has another health care plan that is primary, the individual should submit the claim as follows:

• Request a Request For Benefits form from the Trust Office. Complete this form using the filing guidelines listed on the reverse side of this form.
• Attach the provider’s itemized bill to the Request For Benefits form.
• If the individual is covered under another health care plan or Medicare, and the other plan or Medicare is the “primary” plan (please see Coordination of Benefits With Other Plans And Medicare), include the primary plan’s Explanation of Benefits and itemized bill when submitting the Request For Benefits. The Explanation of Benefits must match the provider’s itemized bill. Inaccurate or incomplete information can create unnecessary paperwork and delay processing.
• Submit the Request For Benefits form, the itemized bill, the primary plan’s Explanation of Benefits (if applicable), and any additional information necessary to process the claim to the Trust Office.
• If the primary plan has prescription drug coverage, submit the claim to the primary plan first. Then submit the primary plan’s Explanation of Benefits or the prescription drug copayment receipt to the Trust Office for additional reimbursement.

Medicare Note

All providers must file claims on behalf of their Medicare patients, whether the claim is assigned or unassigned, or whether the provider participates in Medicare or not (please see Medicare Information). Medicare will pay the provider directly and send a Medicare Summary Notice to the individual showing the amount paid. After Medicare processes the claim, the individual must submit a copy of the Medicare Summary Notice with a copy of the provider’s bill to the Trust Office. The claim will be processed more quickly and accurately if the Medicare Summary Notice matches the provider’s bill.

Claims for services received outside of the U.S. are converted to U.S. currency based upon the conversion rate at the time of service and then paid directly to the retiree. Itemized bills must be translated into English before being submitted to the Trust Office.

The Request For Benefits form is for medical claims, only. If prescription drugs are purchased from a nonparticipating pharmacy, complete a Prescription Drug Reimbursement Form which is available from Medco Health. No claim form is required with the retail pharmacy program and home delivery service. To submit a life insurance claim, please see page 92.

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