MAKING PLAN CHANGES AND FILING CLAIMS. All of the forms mentioned in this section can be obtained from the Employer’s personnel office or Our home office. If the Member needs to submit documentation to Us, the Member may forward it to Our home office at: Blue Cross and Blue Shield of Louisiana P.O. Box 98029 If the Member has any questions about any of the information in this section, the Member may speak to their Employer or call the customer service department at the number shown on his ID card. The Schedule of Eligibility lets the Member know when it is necessary for the Member to apply for coverage to enroll additional family members to the Member’s plan. The Member should read the Schedule of Eligibility and this section as they contain important information. The Employee Enrollment / Change Form is the document that We must receive in order to enroll family members not listed on the Member’s original application/enrollment form. The Schedule of Eligibility will tell the Member whether We require the Employee Enrollment / Change Form and/or the health questionnaire. Because the Member is covered under a Group insurance contract, it is extremely important that the Member follow the timing rules in the Schedule of Eligibility for making these changes to the Member’s policy. If the Member does not complete and return a required Employee Enrollment / Change Form to Us so We receive it within the timeframes set out in the Schedule of Eligibility, it is possible that the Member’s insurance coverage will not be expanded to include the additional family members. Completing and returning an Employee Enrollment / Change Form is especially important when the Member’s first Dependent becomes eligible for coverage or when the Member no longer has any eligible Dependents. If the Member has any changes in their family, the Member must file an Employee Enrollment / Change Form. The Member may also be asked to complete the health questions for these family members. The Schedule of Eligibility explains when coverage becomes effective for new family members. Generally, an Employee Enrollment / Change Form is used to add newborn children, newborn adopted children, a Spouse, or other Dependents not listed on the Member’s original application for coverage. We should receive the Member’s completed form in Our home office within thirty (30) days of the child’s birth or placement, or the Member’s marriage.
MAKING PLAN CHANGES AND FILING CLAIMS. ALL OF THE FORMS NECESSARY TO MAKE CHANGES TO THE PLAN CAN BE OBTAINED FROM THE EMPLOYER’S PERSONNEL OFFICE OR OUR HOME OFFICE. IF THE MEMBER NEEDS TO SUBMIT DOCUMENTATION TO US, THE MEMBER MAY FORWARD IT TO OUR HOME OFFICE AT:
MAKING PLAN CHANGES AND FILING CLAIMS. All of the forms mentioned in this section can be obtained from the Employer’s personnel office, from one of the Claims Administrator’s local service offices, or from the home office of Blue Cross and Blue Shield of Louisiana. If the Plan Participant needs to submit documentation, the Plan Participant may forward it to Blue Cross and Blue Shield of Louisiana at P.O. Box 98029, Baton Rouge, LA 70898-9029, or to 0000 Xxxxx Xxxxxx, Baton Rouge, LA 70809. If the Plan Participant has any questions about any of the information in this section, the Plan Participant may speak to his Employer or call the Claims Administrator’s customer service department at the telephone number shown on his ID card.
A. Adding or Changing the Plan Participant’s Family Members on the Plan
MAKING PLAN CHANGES AND FILING CLAIMS. All of the forms necessary to make changes to the plan can be obtained from the employer’s personnel office, from Our home office. If the Member needs to submit documentation to Us, the Member may forward it to Our home office at: Blue Cross and Blue Shield of Louisiana P.O. Box 98029 All the forms related to filing claims under this Benefit Plan can be obtained by contacting United Concordia Dental at: P.O. Box 69441 Harrisburg, PA 17106-9441 0-000-000-0000 If the Member has any questions about any of the information in this section, the Member may speak to his Employer or call UCD. Members may be able to perform many of these functions online at xxx.xxxxxx.xxx. The Schedule of Eligibility lets You know when You may add additional family Members to Your policy. Please read the Schedule of Eligibility and this section as they contain important information for You. A Group Enrollment Change Form is the document that We must receive in order to enroll family Members not listed on Your original application/enrollment form. The Group Enrollment Change Form is used to add newborn children, newborn adopted children, a Spouse, or other Dependents. It is extremely important that You follow the timing rules in the Schedule of Eligibility. If You do not complete and return a required Group Enrollment Change Form to Us within the timeframes set out in the Schedule of Eligibility, it is possible that Your insurance coverage will not be expanded to include the additional family Members. Completing and returning a Group Enrollment Change Form is especially important when Your first Dependent becomes eligible for coverage or when You no longer have any eligible Dependents.
MAKING PLAN CHANGES AND FILING CLAIMS. All of the forms mentioned in this section can be obtained from the Employer’s personnel office or Our home office. If the Member needs to submit documentation to Us, the Member may forward it to Our home office at: Blue Cross and Blue Shield of Louisiana P.O. Box 98029 If the Member has any questions about any of the information in this section, the Member may speak to their Employer or call the customer service department at the number shown on his ID card. The Schedule of Eligibility lets the Member know when it is necessary for the Member to apply for coverage to enroll additional family members to the Member’s plan. The Member should read the Schedule of Eligibility and this section as they contain important information. If the Member has any changes in their family, the Member must file an Employee Enrollment / Change Form. The Member may also be asked to complete the health questions for these family members. The Schedule of Eligibility explains when coverage becomes effective for new family members. Generally, an Employee Enrollment / Change Form is used to add newborn children, newborn adopted children, a Spouse, or other Dependents not listed on the Member’s original application for coverage. We should receive the Member’s completed form in Our home office within thirty (30) days of the child’s birth or placement, or the Member’s marriage.
MAKING PLAN CHANGES AND FILING CLAIMS. All of the forms necessary to make changes to the plan can be obtained from the employer’s personnel office or from Our home office. If the Member needs to submit documentation to Us, the Member may forward it to Our home office at: Blue Cross and Blue Shield of Louisiana P.O. Box 98029 All the forms related to filing claims under this Benefit Plan can be obtained by contacting United Concordia Dental at: P.O. Box 69441 Harrisburg, PA 17106-9441 0-000-000-0000 If the Member has any questions about any of the information in this section, the Member may speak to his Employer or call UCD. Members may be able to perform many of these functions online at xxx.xxxxxx.xxx.
MAKING PLAN CHANGES AND FILING CLAIMS. If the Subscriber completes the Claim form and this is a Group plan, remember: the Subscriber is the Employee Member (if this is a group contract). If the Subscriber is the patient, the relationship is SELF. If the Subscriber’s wife or husband is the patient, the relationship is SPOUSE.
a. an appropriate Claim form is used b. this contract number (ID #) shown on the form is identical to the number on the ID card c. the patient's date of birth is listed
MAKING PLAN CHANGES AND FILING CLAIMS
