Filing a Claim for Benefits

Hospital and Medical Benefits

All PPO Network and PPO Non-Network claims should be sent to Anthem Blue Cross at the address indicated on your Anthem Blue Cross ID card.

All PPO Network and PPO Non-Network benefit payments will be issued by Anthem Blue Cross. Explanation of Benefits (EOB) will be issued by the Fund Office.

The Fund will accept hospital and medical expense claims for up to 12 months after the date of service subject to contract restrictions between Anthem Blue Cross and providers.

If you receive treatment outside of the United States, submit a detailed, translated bill to the Fund Office.

The bill should include the date services were provided, a description of each service, the charge for each service and the reason treatment was provided (diagnosis). Be sure to also include the type of currency that was used when you paid for these services.

If you have any questions about your claim, call the Fund Office at (866) 400-5200.

Prescription Drug Benefit

If you use a non-participating retail pharmacy for your prescription drugs, you need to file a Prescription Drug Claim Form as provided by the Fund Office. You must pay the full price for the prescription item and submit the claim form to the Fund Office for reimbursement. Reimbursement is limited to a maximum of 60 days for any one individual drug.

To file a claim for prescription drug benefits, follow these steps:

1. Request an itemized bill from the pharmacy showing the following information for each prescription:
   • Prescription number
   • Date of sale
   • Name of the physician who issued the prescription
   • Patient’s name
   • Cost of the prescription
   • National Drug Code (NDC) number for the drug
2. Complete the prescription drug claim form. Make sure you include the Participant’s name and Social Security or OEID number, the patient’s name, address, date of birth and relationship to the Participant, your billing address and the policy number and insurance company name for any other group coverage the patient has. For a copy of this form please contact the Fund’s Member Services Department at (866) 400-5200 or visit our website at www.oefi.org.
3. Attach the itemized bill to the claim form and submit it to the Fund Office.

Dental Benefits

Claim forms for dental benefits may be obtained from the Fund Office, or on the Plan’s website at www.oefi.org. All completed claims should be sent to the Fund Office for processing. All PPO Plan benefit checks, including your Explanation of Benefits (EOB), will be issued by the Fund Office.

When you use PPO, United Concordia, Delta Dental, or Western Dental (MIB) participating dentists, the dentist will file the claim for you.

To file a claim for a PPO Plan non-participating dentist, just request an itemized statement and forward it to the Fund Office.

Vision Benefits

If you use a VSP provider, you do not need to file a claim form. You will pay the amount due from you at the end of the visit, and your provider will take care of billing VSP for the balance.

If you use a non-VSP provider, you will need to request an itemized bill and send it to:

Vision Service Plan
Attention: Claims Services
P.O. Box 385018
Birmingham, AL 35238-5018

Be sure to include the Participant’s name, mailing address and Social Security Number, the patient’s name, relationship to the Participant and date of birth.

Hearing Aid Benefit

To file a claim form for hearing aid benefits, submit an itemized bill to the Fund Office showing the cost of the hearing aid device and the ear in which the hearing aid was placed.

Life Insurance and Accidental Death and Dismemberment Benefits

Life Insurance and Accidental Death and Dismemberment claim forms are available from the Fund Office or on the Plan’s website at www.oefi.org. In the event of death, provide a copy of the death certificate and, if appropriate, written evidence of the accidental nature of the death, to the Fund Office. In the event of dismemberment, notify the Fund Office and a claim form will be sent to you.

For further details, contact the Death Benefits Department at (866) 400-5200.

Weekly Disability Benefit (Southern Nevada Only)

Disability claim forms are available from the Las Vegas Fund Office, the Pasadena Fund Office, on the Plan’s website at www.oefi.org or from the Las Vegas District Office of the I.U.O.E., Local 12. You and your physician must complete the form and return it to the Pasadena Fund Office for processing.

HMO and Medicare Advantage Plan Claims

For services rendered by providers in the HMO Plans (Kaiser, Anthem Blue Cross or Health Plan of Nevada), or by providers in the Medicare Advantage Plans (Kaiser Senior Advantage Plan or UnitedHealthcare Advantage plan) the requirements for filing a claim are different than those outlined above. You should contact the contracting provider if you require information on submitting a claim for reimbursement.

Mental Health, Substance Abuse and MAP Benefits

If you use an MHN Participating Provider, claims will be filed with MHN directly by your provider and payment will be made directly to the provider. If you use a provider that is not an MHN Participating
Provider, you or your provider will need to send the claim to:

MHN Claims
P.O. Box 14621
Lexington, KY 40512

For services rendered on or after January 1, 2022, send all claims to

Carelon Behavioral Health (CBH):
PO Box 1850
Hicksville, NY 11802-1850

Be sure to include the Participant’s name, mailing address and Social Security Number or OEID, the patient’s name, relationship to the Participant and date of birth.

Revised 07/2024