Contracts & Agreements_211-2002 - Laserfiche WebLink

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2). A Post -Service Claim is a written request for benefit determination after a service has been rendered and expense has been incurred. A Post -Service Claim must be submitted to the claims office within Twelve (12) months from the date the expense was incurred. PROCEDURES FOR SUBMITTING A CLAIM A Pre -Service Claim should be submitted to: Affordable Benefit Administrators, Inc. P. 0. Box 10787 Burbank, CA. 91510 (818) 842-0147 or (800) 350-0148 A Post -Service Claim should be submitted to: A P. 0. Box 10787 Burbank, CA. 91510 (818) 842-0147 or (800) 350-0148 Note: In accordance with federal law, the Centers for Medicare and Medicaid Services (CMS) have three (3) years to submit claims when Medicare has paid as the primary plan and the Plan should have been primary. ASSIGNMENTS TO PROVIDERS All Eligible Expenses reimbursable under the Plan will be paid to the covered Employee except that: (1) assignments of benefits to Hospitals, Physicians or other providers of service will be honored, (2) the Plan may pay benefits directly to providers of service unless the Covered Person requests otherwise, in writing, within the time limits for filing proof of loss, and (3) the Plan may make benefit payments for a child covered by a Qualified Medical Child Support Order (a QMCSO) directly to the custodial parent or legal guardian of such child. Notwithstanding any assignment or non -assignment of benefits to the contrary, upon payment of the benefits due under the Plan, the Plan is deemed to have fulfilled its obligations with respect to such benefits, whether or not payment is made in accordance with any assignment or request. No covered Employee or Dependent may, at any time, either while covered under the Plan or following termination of coverage, assign his rights to sue to recover benefits under the Plan, or enforce rights due under the Plan or any other causes of action which he may have against the Plan or its fiduciaries. Note: Benefit payments on behalf of a Covered Person who is also covered by a state's Medicaid program will be subject to the state's right to reimbursement for benefits it has paid on behalf of the Covered Person, as created by an assignment of rights made by the Covered Person or his beneficiary as may be required by the state Medicaid plan. Furthermore. the Plan will honor any subrogation rights the state may have gained from Medicaid -eligible beneficiary due to the state's having paid Medicaid benefits that were payable under the Plan. CLAIMS TIME LIMITS AND ALLOWANCES For group health plans subject to the Employee Retirement Income Security Act (ERISA), the chart below sets forth the time limits and allowance that apply to the Plan ar�d a Claimant with respect to claims filings, administration and benefit determinations. If there is anv variance betw,een the following information and the intended requirements of the law, the law will prevail. Citv of Redlands