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How do I file a claim for benefits under a COBRA or COBRA alternative plan?

The process for filing a claim under a COBRA plan is the same process as a COBRA alternative plan and most all other private health insurance plans.

Health plan rules require that they explain how to obtain benefits and must include written procedures for processing claims. Claims procedures are described in the Summary Plan Description and often on the Web page identified on the insurance ID card. You should submit a claim for benefits as early as possible before with the plan's deadline for filing claims.

As a practical matter, most claims are filed electronically by the doctor or hospital who performed the service. The vast majority of medical insurance claims are quickly processed and paid under this system without any effort on the part of the plan participant. However, this does not relieve the participant from the obligation of making sure that the claim is filed with the health plan. If no benefits response is received from a health plan within a month of the date of treatment, it would be wise to follow up on the claim submission to confirm that a claim was properly filed.

If the claim is denied, you must be given notice of the denial in writing generally within 90 days after the claim is filed. The notice should state the reasons for the denial, any additional information needed to support the claim, and procedures for appealing the denial. You will have at least 60 days to appeal a denial and you must receive a decision on the appeal generally within 60 days after that.

If you have any questions, contact the plan administrator for more information on filing a claim for benefits.

revised 3/1/09

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