Health & Welfare and Pension Funds
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HOW TO FILE A CLAIM

Much of the delay in processing claims can be directly related to incomplete or incorrectly completed claim forms being submitted to the Fund. If you follow the instructions outlined below, you will be helping the Fund provide you with the fastest claim service possible.

The benefits described in this Booklet have a heading for each type of benefit and state who may be covered for that benefit (for example, "Member only," "Member and Spouse only," etc.). For any limitations in your particular plan, please refer to the Summary of Benefits Schedule.

When a Claim Form is Not Needed:

bullet Present your Personal Choice or Keystone HMO identification card for both hospital and non-hospital charges - no claim form is necessary unless you are seeking services from an "Out-of-Network" provider.
bullet  If you are receiving treatment for behavioral health/substance abuse issues, your Provider should submit the claim directly to Total Care Network at the address noted on the back of your medical identification card.

IN ALL OTHER CASES, USE A CLAIM FORM AND FOLLOW
THE INSTRUCTIONS AND GUIDELINES SET FORTH BELOW.


1) GENERAL INSTRUCTIONS:

  1. Claim forms may be obtained from the Fund office or the Fund’s web site (www.teamsterfunds.com), from your Local Union or from your Employer.  
  2. Use a separate claim form for each Family Member. 
  3. Use a separate claim form for each Provider of Service. 
  4. Check each charge and report any errors to the Fund immediately. 
  5. MOST IMPORTANT: Care in filling out your claim form is important. Make sure each appropriate section is completed in full. A great deal of the delay in processing a claim is the result of our having to return claims to busy physicians or members for missing information. Be particularly accurate when writing names, dates of birth, social security numbers, accident information, etc. 
  6. PAYMENT TO DOCTOR OR HOSPITAL - If you wish payment to be made directly to the Provider of Service, sign the appropriate "Assignment of Benefits Statement" contained on the claim form.
  7. PAYMENT DIRECTLY TO YOU - If payment is to be made to you, please attach an original, itemized bill (not a copy) on the physician's or hospital's stationary to the claim form, along with a paid receipt to verify charges and payment. 
  8. BE SPECIFIC - Have your physician provide a detailed bill listing the following: diagnosis, dates of treatment, treatment performed, and charges for each treatment. 

2. FOR MEDICAL EXPENSES:

For your convenience, the Fund has developed a single claim form which may be used for most of your medical expenses. These forms may be obtained either from the Fund office, the Fund's web site or from your Local Union. All you need to do is check the appropriate block at the top of the claim form and follow the instructions given above to obtain your benefits.

3. FOR WEEKLY DISABILITY BENEFITS:

  1. You may use the same claim form you would use for obtaining your medical expense benefits, only please be sure a separate claim form is used for any charges being made by the attending physician. 
  2. Be very certain your doctor has completed his section in full, excluding his charges for services (the doctor's charges must be submitted on a separate claim form). 
  3. Have your employer complete the Company Statement section on the back of the claim form. 

4. FOR DEATH BENEFITS:

  1. Death of Member - Use the Death Benefit claim form. Complete the patient information section of the form and attach a certified copy of the death certificate.
  2. Death of Spouse - Same information as described above, plus a copy of your marriage certificate.
  3. Death of a Child- Same information as for death of a member, plus a copy of the child's birth certificate.

5. FOR MEMBER TOTAL DISABILITY EXTENDED DEATH BENEFITS:

This is a special form obtained only from the Fund office. This form must be completed yearly in order to qualify for coverage.

6. FOR VISION BENEFITS:

The Vision Form may be obtained from the Fund office, the Fund's web site or your Local Union.

7. FOR PHARMACY BENEFITS:

Use your Prescription Drug Card when obtaining your prescription. If the pharmacy does not accept your card, you may still have your prescription filled (or refilled) and file a completed "Direct Pay Card" with the Fund. The “Direct Pay Cards" are obtained from the Fund office for reimbursement by the Pharmacy Card Company. Keep in mind that when using the "Direct Pay Cards" your deductible may be larger because your druggist is charging you whatever the market will bear, but the Pharmacy Card Company will only pay you the Usual, Customary and Reasonable allowance for the prescription.

8. FOR DENTAL BENEFITS:

Because most of the Fund's eligible participants have been receiving dental treatment on a regular basis, all you need generally do to obtain a Dental Claim Form is call the Fund office or print one from the Fund's web site. If, however, any of the following conditions exist, you may be required to be examined by a dentist selected by the Fund prior to beginning treatment:

  1. Orthodontia (Braces) are anticipated (children 10 to 18 years of age only).
  2. You are randomly selected as a part of the Fund's Dental Audit Procedure.
  3. Periodontal Care is anticipated. 
  4. Temporomandibular Joint Disorders.

9. HOW SOON SHOULD YOU FILE YOUR CLAIM? As soon as you can!

Written proof of loss must be furnished to the Fund within ninety (90) days after the date of such loss. Failure to furnish said proof within such time shall not invalidate or reduce any claim if it was not reasonably possible to give proof within such time, providing the Fund's liability position has not been prejudiced by the late filing.

All benefits provided by the Fund will be paid promptly upon receipt of proof of loss. Any benefit payable for loss of the Member's life will be payable to the Member's beneficiary; other benefits will be payable to the member, or the member may assign these other benefits to the Provider of Service.

In the event of an overpayment, either to you or to a "Provider of Service" on your behalf or on a Family Member's behalf, the Fund reserves the right to reduce subsequent Family Member benefit payments by the amount of such overpayment.

No claim will be honored or payable unless the claim is received in and filed with the Fund office prior to December 31st of the third year immediately following the year in which the loss was incurred or services were rendered.  No action at law or in equity shall be brought to recover the allowable benefits prior to the expiration of sixty (60) days after proof of loss has been furnished nor shall such action be brought at all unless brought prior to December 31st of the third year immediately following the year in which the loss was incurred.

 

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 Last Date Updated :  07/24/14