For most* of the benefits under the limited accident & sickness plan, no claim form is required. Simply submit (or have your provider submit) an itemized bill to the Claims Administrator:
Administrative Concepts, Inc. (ACI) 994 Old Eagle School Road, Suite 1005 Wayne, PA 19087-1802
If you have questions about submitting a claim or the status of an existing claim, call ACI toll-free at 1-800-964-7096.
If ACI has any questions about your claim, they will contact you in writing and request any additional information that may be required in order to process your claim.
*Claim forms are required for accidental death or accidental dismemberment claims. Call ACI toll-free at 1-800-964-7096 to request the appropriate claim form.
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