Alaska Teamster-Employer Welfare and Pension Trusts

Section 15 – PAYMENT OF CLAIMS

• 15.1 ENROLLMENT PROCEDURE
• 15.2 SUBROGATION AND REIMBURSEMENT
• 15.3 COORDINATION OF BENEFITS (COB) AND DUPLICATE COVERAGE
• 15.4 WHEN AND HOW COORDINATION OF BENEFITS (COB) APPLIES
• 15.5 HOW MUCH THIS PLAN PAYS WHEN IT IS SECONDARY PAYOR
• 15.6 ADMINISTRATION OF COB
• 15.7 COB WITH MEDICAID, TRICARE, OR VETERANS AFFAIRS FACILITY SERVICES
• 15.8 COB WITH MOTOR VEHICLE NO-FAULT COVERAGE REQUIRED BY LAW
• 15.9 COB WITH OTHER COVERAGE PROVIDED BY STATE OR FEDERAL LAW
• 15.10 COORDINATION WITH MEDICARE
• 15.11 COORDINATION WITH MEDICARE COVERAGE – WHO PAYS FIRST
• 15.12 HOW MUCH THE PLAN PAYS WHEN IT IS SECONDARY TO MEDICARE
• 15.13 HOW TO FILE YOUR CLAIMS
• 15.14 TIME LIMIT FOR FILING CLAIMS
• 15.15 PAYMENT OF BENEFITS
• 15.16 CLAIMS REVIEW PROCESS
  • 15.16.1 MEDICAL BENEFIT CLAIM DETERMINATIONS AND APPEALS
  • 15.16.2 DISABILITY BENEFIT CLAIM DETERMINATIONS AND APPEALS
  • 15.16.3 NON-MEDICAL WELFARE BENEFIT CLAIM DETERMINATIONS AND APPEALS
• 15.17 ASSIGNMENT OF CLAIMS PROHIBITED