How to File Claims

NEW PARTICIPANTS

Submit a completed Family Enrollment Card, along with your marriage certificate and, if necessary, the divorce decree and court orders pertaining to medical coverage for a child, as soon as you become eligible. (A Family Enrollment Card is provided in this booklet.) You only need to complete this form ONCE unless there is a change in your family status (such as a marriage, divorce or birth). NOTE - Before any claims can be paid for a dependent spouse, a certified copy of your marriage certificate MUST be on file at the Fund Office.

Claim Filing Time Limit - Claims must be submitted within two years after the date the claim is incurred. No benefits will be paid for bills submitted more than two years after the date of loss.

Medical (Hospital and Doctor) Claims - All medical bills, for services by PPO and non-PPO providers, should be sent to the Blue Cross Blue Shield (BCBS) office in the state where the provider is located. Most providers will automatically file their claims for you.

When Lineco is the secondary payer to another plan, including Medicare, you must submit a copy of the other plan's Explanation of Benefits form to the Fund Office. Be sure to indicate the name and Social Security number or alternate I.D. of the Lineco employee or retiree when you send these items to the Fund Office, whether the claim is for the employee, retiree or a dependent.

Prescription Drug Claims - Send your prescription drug claims to the Fund Office. Be sure to include the diagnosis or reason for the treatment. Write your name and Social Security number or alternate I.D. as well as the patient's name and relationship to you on all bills and other attachments. Don't send your mail-service co-payment receipts to the Fund Office—these are your responsibility. The date your prescription is filled is considered the "date of service" and the "incurral date" of the claim.

FUND OFFICE ADDRESS
Line Construction Benefit Fund
2000 Springer Drive
Lombard, IL 60148

Note - Medicare-eligible participants can not file prescription drug claims—see page 55 for more information.

Dental Claims - If the dentist's charges will be more than $500, you should first request a predetermination of benefits (see page 65). When the work is completed, have your dentist send an itemized list of services on a standard dental claim form, along with the appropriate x-rays, to the Fund Office.

Your dentist can also file claims electronically through a clearinghouse called Web MD/EmdeonTM. Electronic filing can speed up the submission and processing of your claims. Lineco's Web MD/Emdeon payor ID number is LCB01.

Out-of-Network Vision Claims - If you use an out-of-network provider (a non-VSP doctor) for your vision care, you should pay the doctor in full and request an itemized copy of your bill. Send the itemized bill, along with a completed HCFA-1500 or generic claim form to:

VISION SERVICE PLAN
P.O. Box 997105
Sacramento, CA 95899-7105

Don't send bills for vision care to the Fund Office!

You do not need to file claims when you use VSP doctors.

Hearing Claims - Pay the HearPO or other provider in full and submit an itemized bill to the Fund Office. Be sure to include your name, Social Security number, and the patient's name.

Claims for Weekly Income Benefits - Weekly Income Benefits claim forms are available from the Fund Office. When filing for Weekly Income Benefits, have both your employer and doctor immediately fill in their sections of the claim form and return the form to the Fund Office.

Life Insurance and Accidental Death & Dismemberment (AD&D) Insurance Claims - You (or your beneficiary) should contact the Fund Office for assistance in collecting insurance benefits. Appropriate written proof of your dismemberment or death, including the death certificate, will have to be provided before the insurance company can process the claim.