Postal

 Postal Members:
Claims & Billing Explained

Trusted care—for those who deliver. 75 years and counting.

Navigating Your Health Benefits with Confidence

As a valued member of the NALC Health Benefit Plan for postal employees and retirees, we're committed to helping you understand and use your benefits with clarity. Whether you’re enrolled in the High Option or Consumer-Driven Health Plan (CDHP), this page walks you through your claims, billing details, and key protections under your Postal Service Health Benefits (PSHB) plan.

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How Postal Members File a Claim —Step-by-Step

We’ll walk you through the claims process—so your care gets covered without the stress. Select your plan below to see specific instructions:

View High Option Plan Claims
View CDHP Claims

High Option Plan

Most of the time, you do not need to file claims. Your provider will submit them directly to Cigna (our claims administrator) using the appropriate claim form (CMS-1500 for professional services or UB-04 for facility services).

However, you may be responsible for filing your own claim when:

You receive services outside the United States (submit to: NALC HBP, 20547 Waverly Ct, Ashburn, VA 20149)
You receive services from a non-participating Medicare provider.
You receive services from a Out-of-Network provider

When you do need to file a claim, you must send an itemized bill along with a completed member medical claim form, including:

Patient's full name, date of birth, address, phone number, and relationship to enrollee
Member identification number (from your NALC card)
Provider’s name, address, and tax identification number
Provider's signature with degrees or credentials
Dates of service
Diagnosis and CPT/HCPCS codes (description of services/supplies)
Charges per service/supply
Explanation of benefits from any other health plan if they are primary.
When NALC is primary
NALC Health Benefit Plan
Cigna Payor 62308
P.O. Box 188004
Chattanooga, TN 37422-8004
When Medicare Is Primary
If Medicare doesn’t show that your claim was sent to NALC, send your claim with your Medicare Summary Notice (MSN) to:
NALC Health Benefit Plan
20547 Waverly Court

Ashburn, VA 20149
Mental Health & Substance Use Claims
OptumHealth Behavioral Solutions
P.O. Box 30755
Salt Lake City, UT 84130-0755
CVS Caremark® Prescription Drug Claims
Submit non-network, foreign, or excess refill claims using a short-term claim form. Include detailed receipts and mail to:
NALC Prescription Drug Program
P.O. Box 52192
Phoenix, AZ 85072-2192

SilverScript Prescription Drug Claims / CVS Caremark Medicare Part D Claims Processing
CVS Caremark Medicare Part D Claims Processing
P.O. Box 52066
Phoenix, AZ 85072-2066
Note:If you have other prescription coverage, use that benefit first, then submit your claim to CVS Caremark® with the other insurer’s EOB.

For Claim Status or Claim Related Questions

Call us at:

Consumer-Driven Health Plan (CDHP)

Most of the time, you do not need to file claims. Your provider will submit them directly to Cigna (our claims administrator) using the appropriate claim form (CMS-1500 for professional services or UB-04 for facility services).

However, you may be responsible for filing your own claim when:

You receive services outside the United States (submit to NALC HBP, 20547 Waverly Ct, Ashburn, VA 20149)
You are covered by another insurance plan (including Medicare) that is primary to this Plan
You receive services from a Out-of-Network provider

When you do need to file a claim, you must send an itemized bill along with a completed member medical claim form, including:

Patient's full name, date of birth, address, phone number, and relationship to enrollee
Member identification number (from your NALC card)
Provider’s name, address, and tax identification number
Provider’s signature with degrees or credentials
Dates of service
Diagnosis and CPT/HCPCS codes (description of services/supplies)
Charges per service/supply
Explanation of benefits from any other health plan if they are primary.
When NALC is primary (medical & mental health/substance use)
NALC HBP CDHP
P.O. Box 188050
Chattanooga, TN 37422-8050
When Medicare Is Primary
If your Medicare Summary Notice (MSN) does not show that the claim was forwarded to NALC HBP CDHP, send a paper claim along with the MSN to:

NALC HBP CDHP
P.O. Box 188050
Chattanooga, TN 37422-8050
CVS Caremark® Prescription Drug Claims
Submit non-network, foreign, or excess refill claims using a short-term claim form. Include detailed receipts and mail to:
NALC Prescription Drug Program
P.O. Box 52192
Phoenix, AZ 85072-2192

If another insurer is primary, use that benefit first. Then submit your receipts and the EOB from the primary insurer with your claim form to CVS Caremark®.
SilverScript Prescription Drug Claims / CVS Caremark Medicare Part D Claims Processing
CVS Caremark Medicare Part D Claims Processing
P.O. Box 52066
Phoenix, AZ 85072-2066
Note:If you have other prescription coverage, use that benefit first, then submit your claim to CVS Caremark® with the other insurer’s EOB.
For Claim Status or Claim Related Questions

Call us at:

Your Rights Against Surprise Medical Bills

Understanding Surprise Billing & Balance Billing

When you receive medical care—especially in emergencies—you may not be able to choose your provider. If that provider is out-of-network, you could receive a "balance bill"—meaning you’re charged the difference between the provider's fee and what the Plan pays. This is often referred to as surprise billing.

Your Protections as a Member

The No Surprise Act protects our members from these unexpected costs in key situations:

  • Emergency services received from an out-of-network hospital or provider.
  • Certain non-emergency services received at an in-network hospital or ambulatory surgical center when an out-of-network provider is involved (for example, an anesthesiologist during surgery).
  • In these cases, you only pay your normal in-network cost-sharing (copays, coinsurance, deductibles).

What You’re Still Responsible For

  • Paying your usual copay, coinsurance, or deductible as if the provider were in-network.
  • Checking if your provider or facility is in-network whenever possible, to avoid confusion in situations not covered by these protections.
These payments will count toward your out-of-pocket maximums—just like in-network care.

What Providers Can’t Do

  • They can’t bill you more than your in-network share for emergency and certain hospital-based services.
  • They can’t ask you to waive your rights under the No Surprises Act.
  • They must bill you accurately, based on your plan’s network agreements.

What You Can Do if You Receive a Surprise Bill

  • Don’t pay right away.
  • Contact NALC HBP at 📞 888-636-NALC (6252) for help reviewing the bill.
  • File a complaint with the federal No Surprises Helpdesk at 📞 1-800-985-3059.

Learn More

Download the Official Brochure

Get full details on your NALC Postal Employee Health Plan.

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 FAQs for Postal Employees —Claims & Billing

We’re here to make things simple. Find answers to the most common claims & billing questions.

FAQ representative
A claim is a request for payment that your doctor, hospital, or you submit to the plan after you receive care. It tells the plan what services were provided and what should be covered.
If you see an in-network provider, they usually file claims for you. If you visit an out-of-network provider or get care overseas, you may need to submit the claim yourself.
The plan reviews the claim, processes payment to the provider or to you, and sends you an Explanation of Benefits (EOB) showing what was covered and what you may still owe.
You’ll receive a denial notice with the reason. You have the right to appeal, and instructions for appeals are included in the letter.
No. Emergency care is always covered. If you receive care at a non-network facility, the plan still pays for covered emergency services.
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