Claims
Plans 5, 6, 6A, 11A, 11B
How to File Claims for Benefits:
Alcoholism & Chemical Dependency
Life, AD&D, and Survivor Income Insurance
All claims must be submitted as soon as possible after you receive your services. Medical and dental claims received more than 12 months after the date of service will be denied as untimely. Prescription drug claims will be denied if not filed within 90 days of purchase.
If your claim is for Life, AD&D or Survivor Income benefits, a claim filed more than twelve months from the date the benefit accrued will be denied unless you can show that there was reasonable cause for your delay. In such cases, ReliaStar Life may require you to provide proof substantiating the reason for delay.
In no event, unless because of no fault of your own, will a claim be accepted later than one year after the date services were first received. For information on what to do if you disagree with the decision made in regard to your claim, see “Appeal Procedure”.
Plan 7
For benefits under the self-funded Indemnity Medical Plan (including Prescription Drugs claims), Substance Abuse/Chemical Dependency program, Short Term Disability, the Dental and Vision Plans you or the Provider must file a claim.
If your claim has been denied in whole or in part, you have the right to appeal the decision. Appeals Procedures
For claims administration and appeals under the insured Kaiser HMO and the insured Life Insurance, AD&D and Survivor income plan refer, respectively, to Kaiser’s Evidence of Coverage and the Insurance Company’s Certificate of Coverage for details. You can obtain a copy of the Evidence of Coverage from Kaiser or the Fund Administrator. You can obtain a Certificate of Coverage from the Fund Administrator.
How to File Claims for Benefits:
Alcoholism & Chemical Dependency
TIME LIMIT FOR INITIAL FILING OF CLAIMS
All claims must be submitted to the Plan within 12 months from the date of service. No Plan
benefits will be paid for any claim submitted after this period.
Exception: Where an Anthem Blue Cross provider’s PPO Network agreement allows for a longer time period than twelve months, the claim filing limits contained in that agreement will apply as the Plan terms. However, charges by or claims for out-of-network providers will always be deemed untimely if they are not received by the Administrative Office within twelve months from the date of service.