Common use of Post-Service Claims Clause in Contracts

Post-Service Claims. A Post-Service Claim is a claim for a benefit under the Plan after the services have been rendered. Health claims must be filed with the Administration Office or designated claim processor (Aetna for provider-filed medical claims, Caremark for prescription drug claims and VSP for vision claims) as soon as possible, however all claims must be submitted to the Administration Office designated claim processor (Aetna for provider-filed medical claims, Caremark for prescription drug claims and VSP for vision claims) within one year following the date expenses are incurred. No claim will be considered for payment if it is submitted more than one year after the service is rendered. Benefits are based upon the Plan’s provisions at the time the charges were incurred. Charges are considered incurred when treatment or care is given or supplies are provided. A Pre-Service Claim (including a Concurrent Claim that also is a Pre-Service Claim) is considered to be filed with the request for approval of treatment or services is made and received by the Administration Office in accordance with the Plan’s procedures. However, a Post-Service Claim is considered to be filed when the following information is received by the Administration Office: