All Other Benefits.
A claim form is not required for submission of expenses for benefits other than inpatient Hospitalization or Surgery. Simply mail or fax itemized bill(s) to the Claims Administrator. For All Benefits.
An itemized bill must include the following information:
- member's name and Social Security Number;
- member's name and Sponsor Number;
- patient's name;
- diagnosis code(s);
- procedure code(s);
- provider's name, address, phone number, tax ID number;
- provider's signature. Claims should be submitted within 30 days of the event.
All claims should be submitted to:
Pioneer Management Systems
Attention: Claims
P.O. Box 9040
West Springfield, MA 01090
For claims customer service, call:
Toll Free 1-(866) 653-2542
Monday-Friday 8:00 AM to 5:00 PM |
After receiving written proof of loss, all benefits will be paid to the member, if living, or, in the event of the member's death, to the member's estate. It is not required that the service be rendered by a particular hospital or provider. Payment will be made by Pioneer Management Systems on behalf of the carrier, Markel Insurance Company.
Claim Form
Click the link below obtain a claim form in Adobe Acrobat format.
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