UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS                                   HEALTH and WELFARE FUND

 

Claim Filing Deadline

In order for a claim to be considered for payment, it must be submitted within a certain time frame. Read the information in the following sections carefully to determine the specific claim filing deadline for each benefit. If you file a claim after the deadline, it will not be paid by the Plan. After you file a claim, it must be approved or denied within 120 days after it is received. Accidental Death & Dismemberment Claims must be filed within 90 days of the date of the loss; however, if the claim cannot be filed within such 90 days, it must be filed not later than one year after that 90-day period. Child Care Attendance sheets from non-network centers must be filed for reimbursement no later than 90 days from the date of service. Dental Claims must be filed no later than 1 year from the date of service. Disability The form to be completed by you and your doctor (green form) must be filed within the later of 40 days from the date last worked or 40 days from the date released from the hospital. The form to be completed by your employer( blue form) must be submitted no later than 4 days from your date of absence due to the disability. Educational Benefit Program Claims for reimbursement and/or grade reports must be filed no later than 90 days from the date the semester ends. Life Insurance Claims must be filed within 90 days of the date of the loss; however, if the claim cannot be filed within such 90 days, it must be filed not later than one year after that 90-day period. Medical Coverage (Keystone POS Program) Claims must be filed no later than 1 year from the date of service. Mental, Nervous, Drug & Alcohol Claims must be filed no later than 1 year from the date of service. Physical Well-Being Program Claims must be filed no later than 90 days from the end of the calendar year in which the membership or participation in a program occurred. Prescription Drug Claims for reimbursement must be filed no later than 90 days from the date the prescription is dispensed. Prescription Incentive Program Claims for earned credits and for reimbursement of out-of-pocket costs for using "other prescription drug coverage" must be filed no later than June 30 immediately following the calendar year in which the "other prescription drug coverage" was used by you or your eligible dependents. Also, claims for reimbursement of medical expenses incurred during the calendar year must be filed no later than June 30 immediately following that calendar year. Vision It is the GVA participating provider's responsibility to file the claim no later than 30 days from the date of service.