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NALC Health Benefit Plan ATTENTION Provider Nominations 20547 Waverly Court Ashburn VA 20149 PROVIDER OR CLINIC NAME PROVIDER SPECIALTY ADDRESS CITY STATE TELEPHONE Required fields Your Name optional Last Name NALC Identification Number First Name Please note that Cigna cannot approach or contract with all nominated providers. Dear NALC Health Benefit Plan Member Cigna is committed to superior customer satisfaction* They are interested in receiving referrals from our members regarding provider s you are interested in and/or have a good relationship with and who deliver excellent care. If you are aware of a provider you think might be interested in joining the network who is not currently contracted with Cigna please fill in the provider s name address and telephone number on the lower half of this page and return the form to us here at the NALC Health Benefit Plan* Upon receiving the information we will then submit it to Cigna for possible consideration to the network. Please keep in m....

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We now cover licensed acupuncturists. We now require prior authorization for radiology/ imaging services to include CT/CAT, MRI, MRA, NC and PET scans.

When the NALC Health Benefit Plan is the primary payor for your medical expenses, the seasonal flu vaccine, pediatric/adult pneumococcal, and shingles (Zostovax and Shingrix) vaccines will be paid in full when administered by a pharmacy that participates in the NALC Flu and Pneumococcal Vaccine Administration Network.

Changes to this Plan We now offer the NALC Health Benefit Plan Mobile App. We now require prior authorization for all non-emer- gency air ambulance transport.

Effective January 1, 2023, it's called the NALC High Option Plan — Aetna Medicare Advantage. It's a Medicare Advantage plan, designed exclusively for NALC Health Benefit Plan High Option annuitants, and it is offered to you through the NALC Health Benefit Plan.

Questions? Call the Plan at 703-729-4677 or 888-636-NALC (6252) if you need assistance.

The Federal Employees' Compensation Act (FECA) requires that an original claim for compensation for disability or death must be filed by written notice of injury or occupational disease and file claim for compensation within three years after injury or death.

The NALC Health Benefit Plan offers comprehensive coverage for your medical needs whether you need diagnostic and treatment services, maternity care, or well-child care.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232