Kaiser HMO Plan

Medical coverage may be elected through Kaiser. Kaiser benefits are described in detail by Kaiser brochures, which are available, upon request, from the Plan Administrator at no additional cost.

1. Time Requirements
1. Written notice of a claim must be given to the Trust Administrative Office as soon as reasonably possible.
2. Proof of claim for Hospital confinement must be given to the Trust Administrative Office within ninety (90) days after release from the Hospital.
3. Proof of claim for any other service, supply or treatment must be given to the Trust Administrative Office within ninety (90) days after the service or treatment.
4. If proof of any claim is not given within ninety (90) days, the claim will not be denied or reduced if the proof of the claim was given as soon as reasonably possible. However, no claim will be paid if submitted to the Trust Administrative Office for more than one year after the date of service or treatment. “Proof” means proof satisfactory to the Board of Trustees.
2. Examination
1. The Board of Trustees, at the expense of the Trust, has the right to have You examined by a Provider, as often as it may require, whenever Your Illness or Injury is the basis of a claim.
2. The Board of Trustees has the right to require an autopsy, if not prohibited by law. A disputed Illness is a basis for this requirement.

Vision claims are processed and paid by:

If You are using Postal Prescription Services (PPS) mail-order prescription drug program, You must submit claim forms directly to Postal Prescription Services. Claim forms are available from the Trust Administrative Office or on the web at www.soundcommbenefits.com. Mail Your claim form to:

For Kaiser Permanente enrollees, present Your ID card at Your Kaiser Permanente facility for services and prescription drugs.

If You have a claim concerning benefits provided by Kaiser Permanente Plan, the claim should be filed with the organization in accordance with its claims appeal procedures.