HOW TO OBTAIN BENEFITS
Once you become eligible, this Plan has the responsibility to insure that you receive all benefits to which you are entitled. To assist the Third Party Administrator (Phillips Administrative Service, Inc.) in processing your claim, please follow the steps listed below in the order they appear.
WHEN YOU HAVE A CLAIM:
Step 1. Ask your Doctor for a completed Physician=s statement or an itemized bill with diagnosis. A Abalance due@ statement is not sufficient. Itemized prescriptions from your Pharmacist are acceptable for eligible prescription payment, unless your Plan has a prescription card provision. If so, the prescription card must be used or you will not receive a prescription benefit once a Covered Person has been on the Plan for thirty (30) days. Exceptions may be made for eligible prescriptions not covered by your prescription card, based on individual review. If this Plan is secondary for a Covered Person, you must submit your prescription to Phillips Administrative Service, Inc., for reimbursement of your Co-pay.
Step 2. In the case of Hospital confinements, a form provided by the Hospital must be completed in detail by the Hospital and submitted to PAS, Inc., (UB-92, an itemized bill, including diagnosis page, which all Hospitals are required to provide).
Step 3. Attach all original bills or receipts relating to the health service provided. Make sure the bill is an original and clearly identifies what services were performed and the charge for each service. Also, be sure your name and social security number and your Employer=s name are clearly identifiable.
Step 4. If you have already paid for the services, be sure to clearly and boldly mark all bills PAID.
Step 5. If you have any questions regarding Steps 1-4, call PAS, Inc., for assistance.
Step 6. Forward all related bills to:
PHILLIPS ADMINISTRATIVE SERVICE, INC.
P.O. BOX 218
ALBANY, OR 97321
QUESTIONS ON CLAIMS - CALL: (541) 928-1717
TOLL-FREE: 1-800-356-9822
FAX: 541-928-6039
(If you fax a claim, you must follow up with an original in the mail.)
(In the case of conflicting information, your Schedule of Benefits takes precedence.)