74 • A request for prior approval where prior approval is not required by the Plan; • An eligibility inquiry that does not request benefits. However, if a benefit claim is denied on the grounds of lack of eligibility, it is treated as an adverse benefit determination and the individual will be notified of the decision and allowed to file an a ppeal; • The presentation of a prescription to a retail pharmacy or mail order pharmacy that the pharmacy denies at the point of sale. After the denial by the pharmacy, you may file a claim with the Plan. If you submit a claim that is not complete or lacks required supporting documents, the Plan Administrator or Claims Administrator, as applicable, will notify you about what information is necessary to complete the claim. This does not apply to simple inquiries about the Plan’s provisions that are unrelated to any specific benefit claim or which relate to proposed or anticipated treatment or services that do not require prior approval. How to File a Claim Please make sure that you present your benefit identification card to each provider before you are given any services so that the provider will know that you participate in a Cigna Open Access Plus Preferred Provider Organization. In - Network Benefits If y ou use Cigna Open Access Plus Network providers, your claim for benefits will go directly from the network health care provider (hospital, physician, laboratory, etc.), through an automated electronic system, or through the mail, to the Claims Admi nistrato r for processing. Generally, you are not required to file a claim form for in - network benefits. Out - of - Network Benefits This Plan does not provide out - of - network benefits. Filing a Claim You may file claims for health benefit s and appeal adverse claim d ecisions yourself or have an authorized representative do it for you. Often, the provider will make the claim on your behalf directly to Cigna. If your claim is denied, in whole or in part, you will receive a written notice of the denial from Cigna. The no tice will explain the reason for the denial and the review procedures, including any applicable statute of limitation within which the claimant may file a claim in a court of law. Urgent Care Claims — Submit Directly to Cigna If the Plan requires advance app roval of a service, supply or procedure before a benefit will be payable, and if the Plan or your physician de termines that it is an urgent care claim, you will be notified of the decision not later than 72 hours (shorter depending on medical urgency of th e case) after the claim is received. The decision will be made by Cigna unless the decision relates to your eligibility to participate, in which case it will be made by the Fund Office, acting on behalf of the Board of Trus tees. If there is not sufficient information to decide the claim, you will be notified of the information necessary to complete the claim as so on as possible, but not later than 24 hours after receipt of the claim. You will be given a reasonable additional amount of time, but not less tha n 48 hours, after the end of that additional time period (of after receipt o f the information, if earlier). Other Health Claims (Pre - Service and Post - Service) — Submit Directly to Cigna If the Plan requires you to obtain advance approval of a service, supply or procedure before a benefit will be payable, a request for advance approval is considered a pre - service cla im. You will be notified of the decision not later than 15 calendar days after re ceipt of the pre - service claim.