Submitting Medical Claims

While medical providers handle most in-network and out-of-network claims, some out-of-network providers may require you to submit the claim.

If you need to submit a medical claim, fill out the Benefit Trust Fund Member Claim Form (PDF) and send the completed form to CIGNA using the mailing address shown on the back of your medical ID card.

You must submit a separate claim form for each provider and for each dependent. Complete the claim form in full, including your member ID number and dependent information, where applicable, and submit your signed form along with an itemized bill from the medical provider. Instructions for claims submission are on the Member Claim Form. You must submit a claim within one year after the medical expense is incurred in order for the claim to be processed.

Complete information on how to file a claim for medical benefits is in your Summary Plan Description.

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Medical claims must include a signed Member Claim form and an itemized bill from the medical provider.

Frequently Asked Question (FAQ)

How many different plans does the Fund offer?

The Fund offers multiple Medical, Dental, and Vision plans. Short-Term Disability and Life and Accidental Death & Dismemberment benefits are also available.

How do I notify the Fund of my address change?

If you move, please notify the Fund of your new address. To change your address,
fill out a new Enrollment Form and mail or fax it to the Fund using the mailing address or fax number found on the form. Always complete a new Enrollment Form when you have a change in personal information.

Do Medical Plans include Prescription Drug Coverage?

Yes. Our Plans include excellent prescription drug benefits.

What is a PPO?

A Preferred Provider Organization is a type of medical plan that covers the cost of eligible medical care and services received from network and non-network providers. Network providers (primary care doctors, specialists, hospitals, and other medical facilities) agree to a discounted fee schedule for services provided. When a participant or covered family member sees a network provider for care, the participant pays less out of pocket because of the discounted fees. The Fund contracts with CIGNA Healthcare for the use of their nationwide network of participating providers. There are currently more than 750,000 participating providers in the CIGNA "Open Access Plus" Network—the network used by the Fund’s medical plans.

Are participants required to receive services only from a PPO provider?

No. Participants have the choice of selecting a non-PPO physician. However, receiving services from a physician who participates in the CIGNA network may result in significant savings for participants.

Must participants have a referral from their primary care physician in order to see a specialist?

No. Referrals are not required.

Who processes health care plan claims?

Medical claims are processed by CIGNA Healthcare. Dental claims are processed by Delta Dental Insurance Company, and Vision claims are processed by Fund Office staff.

Do the Fund plans have a waiting period for "pre-existing conditions" under the medical plans?

No. The waiting periods for pre-existing conditions were waived for all plans by the Board of Trustees.

What are the age limits for dependent children?

Children can be covered dependents until they reach age 26 providing they continue to meet provisions for dependent coverage.

Does the Fund offer COBRA coverage for health care?

Yes. The Fund administers COBRA for its Contributing Employers. Upon notification from the Employer that a participant is losing coverage due to a "qualifying event," the Fund will send notification to the participant advising him or her of COBRA rights to continue health care coverage by making payments to the Fund Office.

Does the Fund offer Retiree Health Care Plans?

Yes. Employers that have negotiated a Benefit Trust Plan for their Active employees may also establish a Retiree plan.

How Do I Find a Contributing Employer?

To find a Contributing Employer click on this link to view a map and listings by territory.

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