If you visit a PPO provider, you generally do not have to submit a claim form.  The provider will complete the necessary paperwork.  If you visit an out-of-network provider, you must submit a claim form.

Filing Claims for Your Dependent Child Attending College

When submitting your first claim within a calendar year, you may need to show student documentation (copy of transcript, registration form, class schedule, or tuition receipts).  You may also need to include the name of the college, university, or accredited secondary school your child is attending on all claims for your child.

Claim forms are available from the Benefits Express website.

Aetna generally processes claims within 15 business days of the receipt of the form and documentation.  Claims should be mailed to:

JeffPLUS Aetna PPO

P.O. Box 981106

El Paso, TX 79998-1106

You must submit claims for reimbursement within 12 months of receiving treatment.  Aetna will not process claims submitted six months or more after the date of service.

Personal Choice generally processes claims within 15 business days of the receipt of the form and documentation.  Claims should be mailed to:

JeffPLUS Personal Choice

P.O. Box 69352

Harrisburg, PA 17106-9352

You must submit claims for reimbursement within 12 months.  Personal Choice will not process claims submitted six months or more after the date of service.

After your claim is processed, Aetna or Personal Choice will send you an explanation of benefits statement, outlining how the amount of the benefit, if any, was calculated.  The EOB lets you verify that the claim was processed correctly.  Read your statement carefully.  You will receive an EOB whether you receive care from a PPO provider or not.

Prescription

If you visit an in-network pharmacy, you generally do not have to submit a claim form.  The pharmacy will complete the necessary paperwork.  If you visit an out-of-network pharmacy, you must submit a claim form.  Claim forms are available from the Benefits Express website.  Aetna generally processes claims within 15 business days of the receipt of the form and documentation.  Claims should be mailed to:

Aetna Pharmacy Management

Claim Processing

P.O. Box 14024

Lexington, KY 40512-4024

You must submit claims for reimbursement within six months.  Aetna will not process claims submitted six months or more after the date of service.

If you visit an in-network provider, you generally do not have to submit a claim form.  The provider will complete the necessary paperwork.  If you visit an out-of-network provider, you may have to submit a claim form.

Dental

Delta Dental

If you visit an in-network provider, you generally do not have to submit a claim form.  The provider will complete the necessary paperwork.  If you visit an out-of-network provider, you may have to submit a claim form.

Filing Claims for Your Dependent Child Attending College

When submitting your first claim within a calendar year, you may need to show student documentation (copy of transcript, registration form, class schedule or tuition receipts).  You may also need to include the name of the college, university of accredited secondary school your child is attending on all claims submitted for your child.

Claim forms are available from your Benefits Counselor.  Delta Dental generally processes claims within 15 business days of the receipt of the form and documentation.  Claims should be mailed to:

Delta Dental of Pennsylvania

One Delta Drive

Mechanicsburg, PA 17055

You must submit claims for reimbursement within six months.  Delta Dental will not process claims submitted six months or more after the date of service.

After your claim is processed, Delta Dental will send you a Notification of Delta Dental Benefits outlining how the amount of the benefit, if any, was calculated.  The Notification of Delta Dental Benefits lets you verify that the claim was processed correctly.  Read your statement carefully.  You will receive a Notification of Delta Dental Benefits whether you receive care in-network or out-of-network.

Aetna DMO

If you visit an in-network provider, you generally do not have to submit a claim form.  The provider will complete the necessary paperwork.  If you visit an out-of-network provider, you must submit a claim form to receive reimbursement.  Note: If you receive care from a dentist who does not participate in the Aetna network, you will not be reimbursed for care except in the event of an emergency or other special circumstances. For more information, contact Aetna at (800) The-DMO1 [(800) 843-3611].

After your dental claim is processed, Aetna will send you an explanation of benefits (EOB) statement, outlining how the amount of the benefit, if any, was calculated.  The EOB lets you verify that the claim was processed correctly.  Read your statement carefully.  You will receive an EOB whether you receive care in-network or out-of-network.

Vision

When you visit a VBA participating provider, you must present the provider with a VBA benefit form.  Your provider will submit the benefit form for you.  Benefit forms are available from VBA.

If you visit a non-participating provider, you must pay the provider at the time you receive care or purchase corrective eyewear.  You must then submit a VBA benefit form and itemized receipt to receive reimbursement.  Your itemized receipt must include:

• Patient's name
• Date service began
• The services and materials received
• The type of lenses received (e.g., single vision, bifocal, trifocal).

VBA processes claims bi-weekly.  Claim forms should be mailed to:

Vision Benefits of America

300 Weyman Plaza

Pittsburgh, PA 15236-1588

VBA will not process claims submitted more than 12 months after the date of service or purchase.

After your vision claim is processed, VBA will send you an explanation of benefits (EOB) statement, outlining how the amount of the benefit, if any, was calculated.  The EOB lets you verify that the claim was processed correctly.  Read your statement carefully.

Flexible Spending Accounts

Medical Spending Account

When you or your eligible family member incur a health care expense and are covered under one or more medical, prescription drug, dental or vision plans, you must first file the claim with the medical, dental, or vision plan.  A claim for the unpaid balance, up to your full annual Health Care FSA contribution, can then be submitted for reimbursement.

You may use your debit card where accepted or file a Health Care FSA claim.  To file a claim, complete a Health Care Reimbursement Request form (available from the Benefits Express website) and include a receipt or an explanation of benefits (EOB) from an independent third-party as proof of services rendered.  Note: canceled checks do not serve as proof of payment for health care claims under an FSA.

Your receipt must include:

• Type of service or product provided
• Date the service was performed and/or expenses incurred
• The name of the covered individual to whom the service/product was provided
• Amount of the expense

Your claim should be sent to:

SHPS

FSA Processing Center

P.O. Box 34700

Louisville, KY 40232-4700

Claims Accumulation Period for Health Care Expenses

The claims accumulation period for health care expenses is 14 1/2 months.  This means you can use the money in your Health Care FSA account for eligible expenses you incur during the Plan Year and the first 2 1/2 months of the following plan year (called the "Grace Period").  This also applies to qualified beneficiaries with COBRA coverage under the Health Care FSA.

Claim Submission Deadline

You must submit claims for reimbursement of health care expenses by March 31st (called the "Run Out Period").  This deadline applies to expenses incurred during the entire claims accumulation period (the plan year and the Grace Period).

Claims Processing

When SHPS receives your claim, it will be processed and all claims incurred during the previous plan year will automatically be reimbursed from your previous year Health Care FSA account.

Claims incurred during the Grace Period will be reimbursed from your previous year account only if you have a remaining previous year Health Care FSA account balance after the Run Out Period ends and all previous year claims have been reimbursed.

Dependent Care Spending Account

When you incur an eligible dependent care expense, you must file a Dependent Care Reimbursement Request Form in order to receive reimbursement from the Dependent Care FSA.  Include a receipt or an itemized bill as proof of services provided.  Note: canceled checks do not serve as proof of payment for dependent care claims under an FSA.

Your receipt must include:

• Type of service provided
• Date the service was performed and/or expenses incurred
• Your name or dependent for whom the service was provided
• The Social Security Number, Federal Tax Identification number, or non-profit information of the person or organization providing the service
• Amount of expense

You may also have the affidavit portion of your Dependent Care Reimbursement Request Form filled out by your provider.  This may be submitted in lieu of a receipt or itemized bill.

Your claim should be sent to:

SHPS

FSA Processing Center

P.O. Box 34700

Louisville, KY 40232-4700

Claims will be processed within two weeks after the date submitted.  Checks will be sent directly to you, not the provider of service.  The minimum amount you can receive a reimbursement check for is $50.  SHPS will retain your claims until the aggregate amount reaches $50.

You must file claims by March 31 of the year following the year in which you incur the eligible expense.  For example, if you incur an expense (the service is provided) in July, you have until March 31 of the following year to file the claim for reimbursement.

You will be reimbursed with funds in your account, up to the available balance on the day the claim is processed.  If your reimbursement request exceeds your available account balance, you will receive partial reimbursement in the amount of your available account balance.  The rest of the claim will automatically be reimbursed as you continue to contribute to the account until the expense is fully paid or until you reach the annual amount elected (whichever comes first).  You do not need to resubmit that claim.

The total amount of reimbursement through the Dependent Care FSA will be reported on your W-2 each year.

You can receive account balance information Monday through Saturday from 8 a.m. to 2 a.m. Eastern Time by calling AccountLink at (800) 678-6684.  If you have questions about FSAs, you may also visit the SHPS website at http://www.shps.net/.

Disability

You must file a claim (request certification) to begin receiving STD and LTD benefits.  You should call Nationwide Better Health (NBH) at (877) 456-8677.

During the call, you will need to provide:

• Information about your injury or illness
• Information about your job responsibilities
• The name and address of your physician
• The name and telephone number of your MLH supervisor

If you are disabled and are filing for STD, you should call NBH within 7 days after the date your disability begins or as soon as reasonably possible.  You must file a claim with NBH no later than 90 days after your elimination period ends.

After you call NBH:

• An NBH Registered Nurse will contact your physician to obtain medical information.  He or she will also contact your supervisor to obtain information about your job requirements.
• Within approximately 5 to 7 days, NBH will mail you a certification letter stating your approved length of disability or the reason for denial.
• If your claim is approved, you must coordinate your disability absence with your supervisor.

If you fail to file your claim in a timely manner, benefits will not be payable unless:

• The reason you failed to file the claim in a timely manner is not of your own fault, and
• Your claim (request for certification) was made as soon as possible (no later than one year after the deadline, unless you are legally incapacitated), and
• NBH is able to certify your period of disability.

Once you file for disability benefits, NBH may require you to be examined by doctors or other medical professionals of their choice.  They may also require you to be interviewed by NBH representatives.  NBH will pay for these examinations.  If you decline to be interviewed or examined, your disability claim may be denied.

Life/AD&D

To file a claim for life and/or AD&D benefits, you or your beneficiary should contact your Benefits Counselor immediately after you or your covered dependent's injury or death to request the appropriate forms.  You must provide Lincoln with a written notice of your claim within 20 days of the date of the death or the accident that caused the injury or death.  Within 15 days of receiving your notice of claim, Lincoln will then send you claim forms.  You must complete the forms and provide any requested proof of the claim to Lincoln within 90 days of the date of the loss.

Appealing a Claim Denial

If you or your beneficiary's claim is denied in whole or in part, Lincoln will notify you or your beneficiary of the denial in writing.  The notice will explain why benefits were denied.  To appeal the denial, you or your beneficiary must write Lincoln within 60 days of the date of the denial letter.  In your correspondence, you should explain why you think your claim should not have been denied.  You should include any documents or additional information that is relevant to your appeal.

Lincoln will review the request and notify you in writing within 60 days of receiving your appeal.  In some cases, Lincoln may require more than 60 days to review your claim.  You will be notified if an extension is necessary.  For more information, contact your benefits counselor.