Acceptable supporting documentation for medical claims must include the following information:
- Name of provider
- Date of service/date product was purchased
- Type of service/product (drug name required for prescription claims)
- Your out-of-pocket expense for the service/product (amount not covered or reimbursed elsewhere)
- Name of participant or dependent for whom the service/product was provided
For services covered in whole or in part by insurance, the expense must first be submitted to your insurance carrier. The insurance carrier will issue an Explanation of Benefits (EOB) to you, indicating your out-of-pocket cost and the amount covered by your insurance. When you submit your claim, include the EOB with your completed claim form.
