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INSURANCE FAQ - Grievances and Appeals

Your Grievance and Appeals Rights:

There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal.

For more information about your rights, look at the Explanation of Benefits you will receive for that medical claim. Your plan documentation also provides complete information to submit a claim, appeal, or a grievance for any reason to your plan.

For additional information about your rights, or assistance, contact:
your Health Insurance Provider
(listed below), or the

State of Illinois Department of Insurance
Office of Consumer Health Insurance
https://insurance.illinois.gov/healthinsurance/OCHIFactSheet.pdf

United Healthcare  **Medicare Advantage type**

          https://www.uhcretiree.com/soi/appeals_and_grievances.html

Appeals address:
Appeals and Grievance Department
P.O. Box 6106, Mail Stop CA124-0157
Cypress, CA 90630

Coventry Advantra (An Aetna Company) **Medicare Advantage type**

https://www.coventry-medicare.com/state-of-illinois/en/contact-us/appeals-grievances.html

Health Alliance **Medicare Advantage type**

            https://medicare.healthalliance.org/content/complaint

Humana **Medicare Advantage type**

If you have any questions about the plan, call Humana at 1-800-951-0125 (TTY: 711).
You can call Monday through Friday from 8 a.m. to 8 p.m. Central time         

EyeMed

            https://www.eyemedvisioncare.com/stil/public/faqs.emvc

Delta Dental of Illinois

            http://soi.deltadentalil.com/claims%20appeal%20procedures.pdf



State of Illinois State Employee Group Insurance Plan (SEGIP) Administrator Contacts

State of Illinois Retiree TRAIL MAPD Administrator Contacts

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Email usretire@RSEA4U.org