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Receiving Your Benefits

Filing a Claim

Maroon Plan

You do not have to file a claim if you seek medical care from a network provider. If you use an out-of-network provider, file your claims within 24 months after the date you receive a covered service or supply. Otherwise your claim will not be paid as it will have exceeded the filing limit. To file a claim:

  1. Download the claim form from the Benefits website:
    http://hr.uchicago.edu/forms/benefits.html#health
  2. Complete the form.
  3. Attach copies of the bills for the services and supplies, including:
  • The provider’s name and address.
  • The patient’s name.
  • Diagnosis.
  • Date of service.
  • Description of service.
  • Charge for service.
  1. Mail the completed form and attachments to the claims administrator.

Be sure to keep copies of your claim forms and all supporting documentation. After your claim submission is processed, payment will be sent to you. You will receive a statement, called an Explanation of Benefits, telling you what was paid and the amount, if anything, you still owe to the provider. File separate claims for each covered individual.

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While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.

 

 

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