Coronavirus-Benefits

The claim filing procedure under the Health & Welfare Fund is intended to help process your claims as quickly as possible. Claims filed later than ninety (90) days after date of treatment or hospital confinement began may be denied, unless there is satisfactory explanation for the unavoidable delay. However, in no event will the Fund consider any claim filed more than one (1) year of the date of service. Additionally, you must provide all necessary information at the time the claim is filed. Any claim form received with incomplete information will cause delays in processing.

In case of the death of a member, an authorized representative MUST PROVIDE A CERTIFIED DEATH CERTIFICATE. Your representative will be furnished the necessary forms, which must be completed and returned to the Fund Office for payment of the claim. All claims must be filed within ninety (90) days of the date of the member’s death.

Where pre-authorization is noted, American Health must be contacted at 1-866-457-0533, prior to the rendering of any service. For all other benefits, there generally are no claims to you to file because the providers will submit the claim form to BlueCrossBlueShield/Anthem, on your behalf, pursuant to their contract with the respective PPO Network. However, if you desire to submit a claim form on your behalf, you may print a claim form and have it completed by your doctor, then mail it to the address below. You may also submit a claim for benefits on the universal HCFA-1500/UB92. To assure prompt processing of your claim, you must make sure all claims have the following:

– Name of Member
– Member’s ID Number
– Name of Patient
– Date of Service
– Type of Service (with appropriate codes)
– Diagnosis
– Amount of Charge
– Physician or Hospital Name and Address
– Physician or Hospital TIN Number and/or ID Number

All hospital and medical claims are to be submitted to:

Empire Blue Cross and Blue Shield

P.O. Box 3877

Church St. Station

New York, NY 10008

When you or your eligible dependent needs dental treatment, call the dental service at 1-800-468-0600 to find a participating dental office closest to home or work. Then, call the participating dentist and be sure to identify yourself as a participant of the UFCW Local 2013 Health and Welfare Fund when you make your appointment. The dentist will verify your eligibility with the dental service.

At the time of your visit, present your Healthplex ID card to receive discounted rates on dental procedures. Your dental provider will file claims directly with the Plan’s dental provider, which will handle all claims processing and administrative services, including paying your dental provider directly for your covered dental benefits.

Select a VBA participating provider in your area. When scheduling an appointment, please notify the VBA participating provider that your vision coverage is administered by VBA. A list of participating providers is available on their website at VBAPlans.com. The provider selected will contact VBA to verify eligibility via an online system and will process services received electronically.

If you choose to see a non-participating provider, make an appointment and pay the provider their full fee. Obtain an itemized receipt which must contain the following information: patient’s name, date services began, services and/or materials received, and type of lenses (single vision, bifocal, etc.). There is no assurance the non-participating reimbursement schedule will cover the entire cost of the examination, glasses or contacts.

Mail your receipts along with a VBA out-of-network reimbursement form (which can be printed online at VBAPlans.com) to:

VBA
300 Weyman Road, Suite 400
Pittsburgh, PA 15236-1588

As part of our continuing efforts to deliver the best and most cost effective health plan, BCBS is the Plans PPO Network. The website for Anthem is www.anthem.com.

Express Scripts provides a full scope of Pharmacy Benefit Management services.

VBA maintains a network of more than 16,000 participating optometrists, ophthalmologists and retail locations nationwide to provide professional vision care for those covered under the plan.

Provides dental benefits and administrative services for insurance companies, HMOs, school districts, labor unions, families, municipalities, welfare funds and businesses of all sizes. www.Healthplex.com

Magnacare provides a full scope of Pharmacy Benefit Management services. They manage the clinical aspects of Pharmacy Benefit Management, such as Disease Management, Formulary, Drug Utilization Review and audits, among other things. www.MagnaCare.com

With experience in the optical field for over 30 years, Comprehensive Professional Systems and and Vision Screening have put together a group of professionals with the same vision for standard in excellence when it comes to providing eye care. They believe that proper credentialing, quality control, and customer service are the keys to every plan it administrates. www.cpsoptical.com and www.VisionScreeningInc.com