Benefits Summary Plan Description

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Filing Claims

If an employee or a covered dependent dies or is seriously injured, the appropriate insurance company should be notified immediately.

For the 2018 plan year, Life Insurance and Group Universal Life (GUL) Insurance claims should be submitted to:

The Prudential Insurance Company of America
P.O. Box 8517
Philadelphia, PA 19176
1-888-257-0412 (phone)
1-888-227-6764 (fax)

For the 2018 plan year, Accidental Death & Dismemberment claims should be submitted to:

Life Insurance Company of North America
Life Claims
P.O. Box 22326
Pittsburgh, PA 15222-0326
1-800-238-2125 (phone)
1-412-402-3506 (fax)

After receiving notification, the insurer will process the claim for payment of benefits. All claims for benefits must be made by filing a properly completed form. If the claim is for a death benefit, a death certificate must be furnished along with the claim form.

If a participant has concerns about how a claim has been administered or wishes to appeal a claims decision, information on relevant procedures is available in Claims Appeal and Review Procedures Under ERISA section.

Claim Forms