Claims Information

Self-Funded Medical Claims Look-Up

Where to file a claim

All Life, Dental and Professional Medical claims should be sent to the Administrator’s Office at:

UNITED ADMINISTRATIVE SERVICES
1120 South Bascom Avenue
San Jose, California 95128
Telephone (408) 288-4400

MAILING ADDRESS:
P.O. Box 5057
San Jose, California 95150

All Hospital Claims should be sent to:

Prudent Buyer Plan
P. O. Box 6007
Los Angeles, CA 90060-0007

PROVIDERS may call (800) 274-7557 for medical pre-authorization or pre-service review.

When to file a claim

You should file a claim as soon as you or one of your eligible dependents have incurred covered expenses for which the Plan provides benefits. You should not wait until the end of the year to submit your claim. It is the member’s responsibility to verify with their provider that the claim was filed on a timely basis.

Dental Claims

Obtain a claim form from the Administrator’s Office, your Participant Union, or your employer. Complete Part 1 of the dental claim form and ask your dentist to complete Part II and forward it to the Administrator’s Office for processing. Please note that for non-emergency services totaling more than $300, the dentist should submit a Dental Treatment Plan to the Administrator’s Office for approval.

Vision Claims

If you go to a VSP participating doctor he or she will submit the claim to VSP.

If services are received from a provider other than those in the listing, reimbursement will be made to the subscriber up to the schedule of allowances for like services and/or materials. Send a copy of the itemized bill(s) to VSP. The following information must also be included in your documentation:

Member’s name and mailing address.
Member’s identification number (usually the social security number).
Member’s group name (Bay Area Roofers Health and Welfare Plan).
Patient’s name, relationship to member and date of birth.

Please mail the itemized bill(s) and form to the following address:

VISION SERVICE PLAN
Attn. Out of Network Claims
P. O. Box 997100
Sacramento, California 95899-7100