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Summary Plan Description (SPD)
How to File a Claim
When sending a claim to the Administrative Office, follow these steps:
- Obtain a Medicare Supplement claim form from the Administrative Office or Allied Administrators.
This section replaced by: Amendment 13. View Previous Language
- Use the Medicare Supplement claim form when submitting bills and claims to the Administrative Office for payment.
- Complete parts One and Two of the Medicare Supplement Claim form.
- Attach all Explanation of Medicare Benefit forms to the claim form.
- Date and sign the claim form, keep the bottom portion of the claim form (Part Two) for your own personal records.
- Claim forms should be mailed to the following:
IBEW-NECA Claims Administration
Allied Administrators
2831 Camino del Rio South
Suite 311
San Diego , CA 92108-3829
Telephone: 1-800-736-0401
Upon receipt of a fully completed claim form, Allied will process your claim and issue any reimbursement to which you may be entitled within the time frames established by applicable federal regulations. These timeframes are described on pages 209 – 213 in this Summary Plan Description under the heading “Claims & Appeal Rules.”
Note: Send in no more than one claim form per month, with all claims for both retiree and spouse listed on the same claim form.