Get the free (PEHP) Claim Form

PLEA PEP CLAIM FORM As an active city of Phoenix employee who is a member of the Phoenix Law Enforcement Association (PLEA), a PLEA Post Employment Health Plan (PEP) account has been established on

How to fill out pehp claim form

How to fill out a PEHP claim form:

1. Start by gathering all the necessary information and documents. This may include your personal details, such as your name, address, and contact information, as well as your policy number and any relevant medical records or receipts.
2. Carefully read the instructions provided on the PEHP claim form. Make sure you understand the requirements and any specific guidelines before proceeding.
3. Begin filling out the form by providing your personal information in the designated fields. This may include your name, address, phone number, and policy number. Double-check the accuracy of the information to avoid any processing delays.
4. Specify the details of the medical service or treatment for which you are filing the claim. Include the date, provider name, type of service or treatment received, and any relevant diagnosis or procedure codes. This information is crucial to ensure accurate processing of your claim.
5. Use the appropriate sections of the form to provide information about any accompanying dependents or secondary insurance coverage, if applicable. This information helps PEHP determine coordination of benefits and process your claim accordingly.
6. Keep track of any supporting documentation that may be required for your claim. This can include itemized bills, receipts, prescriptions, or any other relevant documentation. Make copies of these documents before sending them along with the claim form.
7. Review the completed form and attached documentation to ensure everything is accurate and complete. Double-check for any missed or incorrectly entered information.
8. Make copies of the fully completed form and all attached documents for your own records.
9. Submit the claim form and accompanying documentation to the address indicated on the form or as provided by PEHP. If submitting via mail, consider sending it through certified mail or with tracking to ensure safe delivery and receipt.
10. Keep track of the submission date and any relevant tracking information to follow up on your claim if necessary.

Who needs a PEHP claim form?

1. PEHP claim forms are required by individuals who are covered under a PEHP insurance plan. This includes employees of participating organizations, such as state and local government employees, as well as their dependents.
2. Individuals who have received medical services from healthcare providers who accept PEHP insurance and want to request reimbursement for those services will need to fill out a PEHP claim form.
3. Those who have secondary insurance coverage in addition to their PEHP plan may also need to fill out a PEHP claim form to coordinate benefits between the two insurance providers. This ensures proper processing and helps avoid any out-of-pocket expenses.

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