Benefits Handbook

If you use an in-network provider, in almost all cases, you do not have to file a claim form. In the very rare cases that you might need to file a claim, contact the Claims Administrator.

If you receive services from a provider who does not participate in the network, those services will not be covered. Out-of network benefits are not covered under the Plan except in an emergency.

There are special rules, procedures and deadlines that apply to appeals of benefit determinations and denied claims and you have special legal rights under ERISA. Please refer to the Administrative Information section for a description of the appeal process.