New PPO Plan for Out-of-Area Participants
The ULLICO PPO Plan for active members who live outside of an HMO area was terminated September 1, 2007 and replaced by Health Net PPO Plan. Participants who were enrolled in the ULLICO Plan with continuing eligibility into September 2007 were transferred into the Health Net Plan; however, the participants need to complete the enrollment form that was sent to them and return the completed form to the SUP Welfare Plan.
If you were enrolled in ULLICO and did not receive the information, please contact the Plan office at 1-800-796-8003.
Timely Filing of Claims
REMINDER: Reimbursement for co-payments and other eligible medical, dental, vision, or prescription charges must be submitted to the Plan office within 90 days of the dates of service. This time limit for filing claims includes eligible expenses for active employees and pensioners covered under the pensioners’ annual allowance.
The Pensioner Annual Hospital Medical Benefit Reimbursement Claim Form is required to be completed and sent to the Plan office at least once every fiscal year. A blank form is included with payments sent to pensioners along with payments for reimbursement. If you need a form, please contact the Plan office at 1-800-796-8003 or 415-778-5490.
Invoices that state “This is not a bill” and proposed treatment plans are not adequate proof of loss for reimbursement under the Pensioners’ Annual Allowance. Please submit itemized bills that include the name of the patient, the name and address of the provider of services, the charge, and the dates of service. Medicare explanations of benefits and itemized prescription bills with the above information are also acceptable.
You can e-mail questions to the SUP Welfare Plan at the following e-mail addresses. To protect your privacy do not include your social security number or other sensitive personal information in your e-mails.
Michelle Chang, Administrator: firstname.lastname@example.org
Patty Martin: email@example.com
Virginia Briggs, Claims: firstname.lastname@example.org
Michael Jacyna, Eligibility: email@example.com
Terry O’Neill, Training Representative: firstname.lastname@example.org