Pre-Service Claims

Pre-service claims are claims for benefits that the Plan requires pre-authorization before you receive medical care.

For all of the plans listed above, there are no pre-authorization (prior approval) requirements for urgent medical care or medical emergencies.  If you require urgent medical care, you should seek immediate medical attention or dial 911 as may be required.

Other Plans
There are no pre-certification requirements for urgent care under the Prescription Drug Program, Self-Funded Dental Plan or the Vision Plan.

Independent Medical Opinions
These pre-service claims and appeals involve issues predicated upon medical necessity and the appropriateness of requested medical care.  While the Board of Trustees are the named fiduciaries responsible for the final determination of your pre-service appeal, the Board of Trustees does not possess medical expertise.  Therefore, the Board has established a policy of adopting as its own opinion the opinion(s) received from outside independent medical doctors and review organizations, which is most favorable to you.