The Claim Administration Agent (Regence; Kaiser Permanente; Providence HealthPlan; VSP and CVS/Caremark) will process a properly filed claim within 30 days of its receipt. This 30-day period can be extended for 15 days if the circumstances require. If additional information is needed to process your claim, you will be notified of the additional necessary information and be given up to 45 days to produce it.

If your claim is denied in whole or in part, the Claim Administration Agent will provide you with a notice identifying the reasons for the denial, any additional information necessary to consider your claim, your right to obtain additional information and the Trust's claims appeal procedures. Please note that these procedures are partially modified (as discussed below) if your claim involves an urgent care claim.