Claim Procedures

This section is designed to provide an overview of the claims process for the various benefit programs offered through ISEBA. Please review your benefit booklet-certificate for a complete summary of benefits and detailed claims procedures. Planholders may contact ISEBA to receive a supply of any of the claim forms mentioned in this section, or you may print the claim forms right from our site.

Wellmark

Most doctors and hospitals will file claims automatically to Wellmark. However, if your doctor or hospital requires a claim form, complete the Wellmark Claim form and send it to the address on the form. Sending the claim form to Wellmark's home office will delay the processing of your claim form. Depending on your benefit plan, failure to obtain Hospital Preadmission Authorization may result in reduced benefits. Please check your benefit booklet-certificate for details.

Limited Benefit Medical Plans

HM Life

To file a claim for HM Life's limited benefit medical plan, please print their claim form and mail it to:

Most dentists will file all claims directly to Delta Dental Plan of Iowa. However, a non-participating dentist may ask members to file claims. Members should ask the dentist to complete a standard American Dental Association (ADA) claim form, or Delta's form, and mail it to:

Delta Dental Plan of Iowa
P.O. Box 919
Ankeny, Iowa 50021-0919

Vision Plans

Avesis

For vision claims, please fill out the Avesis claim form and mail it to:

Members, or their authorized representative, are encouraged to notify UNUM as soon as possible of a claim, so that a claim decision can be made in a timely manner. Members, or their authorized representative, and the Employer must complete the appropriate sections of the claim form before giving it to the claimant's attending doctor. The doctor should complete his or her section and send the form directly to UNUM. Please note in some cases, you will be required to give UNUM authorization to obtain additional medical and non-medical information to prove the claim or proof of a continuing disability. UNUM will deny your claim if appropriate information is not submitted.

Life, AD&D and LTD claim forms may be obtained by visiting our forms page.

Please refer to your benefit booklet-certificate for a summary of benefits and a complete description of the claim filing procedures, including what information is required to prove the claim.

If a claim is based on your disability, the Life/AD&D claim form and supporting documentation must be sent no later than 90 days after the end of the elimination period.

If a claim is based on death, the Life/AD&D claim form and supporting documentation must be sent no later than 90 days after the date of death.

If claim is based on death or other covered loss, the Life/AD&D claim form and supporting documentation must be sent no later than 90 days after the date of death or the date of any other covered loss.

If claim is based on the Education Benefit, the Life/AD&D claim form and supporting documentation must be sent no later than 60 days after the date of death.

The LTD claim form and supporting documentation should be sent within 30 days after the date your disability begins. However, you must send UNUM written proof of your claim no later than 90 days after your elimination period.

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  Last updated: Friday, July 10, 2009  Page: 

This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.

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