How to File a Claim with Your NALC Health Benefit Plan High Option

Filing a claim for your health care can sometimes feel confusing, especially if you’re new to the process. The good news is that most of the time, you won’t need to file claims yourself—your doctor, hospital, or pharmacy will take care of that for you.

However, there are times when you’ll need to submit a claim on your own. Knowing when and how to do it helps ensure your reimbursement is processed quickly and accurately. The NALC Health Benefit Plan (High Option) makes it simple, with clear steps and dedicated support every step of the way.

For more information about your High Option Plan coverage, visit the High Option Plan page.

When You Need to File a Claim Yourself

Most members never have to file their own claims—but if any of the following apply, you’ll need to take the lead:

• You received medical services outside the United States.
• You paid for care out of pocket because your provider doesn’t file claims or isn’t part of the network.
• Another health plan is your primary coverage. In this case, you’ll need to submit your Explanation of Benefits (EOB) from the other plan along with your claim to NALC HBP. 

If you’re unsure whether you need to file, you can always check with your provider or contact the Plan directly through the Contact page.

Information You’ll Need

Before you submit your claim, gather a few key details. Missing information can delay processing, so it’s always worth double-checking that everything is included.

Here’s what you’ll need:

• Patient information: name, address, date of birth, and relationship to the member.
• Member details: your NALC Health Benefit Plan ID number from your ID card.
• Provider information: name, address, Tax Identification Number (TIN), and credentials (MD, DO, RN, etc.).
• Service details: dates of service, type of service, diagnosis, and procedure codes (if available), and amount charged.
• Other coverage information: if another plan paid first, include a copy of their Explanation of Benefits (EOB).
• Receipts or statements: showing what was paid and to whom.

Visit our Claims and Billing page for detailed guidance on when filing is necessary and how the process works. 

Where to Send Your Claims

Different types of claims go to different addresses. Submitting to the right location helps ensure your claim is processed without delay.

Medical Claims

Mail your completed claim form and supporting documents to:
NALC Health Benefit Plan
PO Box 8300
Carmel, IN 46082-8300

Mental Health or Substance Use Claims

Mail to:
NALC Health Benefit Plan
PO Box 6189
Indianapolis, IN 46206-6189

Medicare Primary Claims

If Medicare is your primary coverage, your provider should file claims directly with Medicare first. Medicare will then forward your claim automatically to NALC HBP for secondary payment—no extra steps needed.

Prescription Drug Claims

If you paid for a covered prescription out of pocket, complete a Prescription Drug Claim Form and mail it to:
NALC Prescription Drug Program
PO Box 521920
Miami, FL 33152-1920

Be sure to include pharmacy receipts that show the prescription number, drug name, date, and cost.

Tips for a Smooth Claim Process

A few simple steps can help make your claim experience faster and stress-free:

1. Double-check your information – Verify your member ID, provider details, and amounts before sending. 
2. Keep copies – Always make copies of your claim form, receipts, and any correspondence. 
3. Sign and date the form – Unsigned forms can’t be processed. 
4. Include all documentation – Especially EOBs when another plan paid first. 
5. Ask about prior authorization – For certain services, prior approval may be required before filing. 

Not sure if your service needs prior authorization? Visit the Prior Authorization page or ask your provider before submitting a claim.

If Something Goes Wrong

Sometimes, a claim might be delayed or denied. It’s okay—this can often be corrected with a little follow-up.

Here’s what to do:

• Review your Explanation of Benefits (EOB) to understand why it was denied. 
• Check for missing or incorrect information—for example, the provider’s Tax ID or date of service. 
• Contact the Plan for guidance on how to resubmit or appeal. 

You can always reach out via the Contact page or find helpful answers in the FAQs. The team is there to help ensure your claim gets back on track.

You’re Not Alone in the Process

Filing a claim may seem like one more task on your to-do list, but you don’t have to handle it alone. The NALC Health Benefit Plan team is here to make sure you understand your options and get reimbursed for the care you’ve received.

If you ever have a question, reach out to the Plan’s customer service or visit the High Option Plan page for more information.

Your health—and peace of mind—come first. Taking a few minutes to file correctly ensures your benefits work smoothly, so you can focus on what matters most: feeling your best.