75 • 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 e ligibility, it is treated as an adverse benefit determination and the individual will be notified of the decision and allowed to file an appeal; • 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 wha t 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 prio r 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. Non - Preferred Providers may require that you pay them first and that you seek reimbursement by filing your own claim with Cigna. Network Benefits If you use Cigna Open Access Plus Network providers, your claim for benefits will go directly fr om the network health care provider (hospital, physician, laboratory, etc.), through an automated electronic system, or through the mail, to the Claims Administrator for processing. Generally, you are not required to file a claim form for in - network benefi ts. Out - of - Network Benefits If you use out - of - network providers not affiliated with the Cigna Open Access Plus PPO Network, you may be required to submit your own completed claim form and follow the claims procedures outlined i n this Section, as applicabl e. You may obtain claim forms from the Fund Office, Cigna, or by going online at www.iambtf.org . To expedite the processing of your medical claim, please be sure to complete the form thoroughly, including information about Medicare eligibility and any other group benefits that may be payable on your behalf. Your written claim must be mailed to Cigna as soon as reasonably possible after the expense is incurred, but in no event more than one year after the expense is incurred. Note: Any claims Cigna receives more than one year after the expense is incur red will be denied as untimely. Also, Cigna may h ave shorter filing limits for their network providers. You will not be responsible for payment of charges Cigna denies for untimely filing if a Cigna contracted provider fails to file your claim in accordance with Cigna’s contractual requirements. The fol lowing information must be completed on the claim form in order for your request for benefits to be considered a claim, and in order for the Plan to be able to process your claim. You complete the Employee portion of the claim form, providing the following : • Participant name; • Patient name; • Participant member id and account number • Patient date of birth; and Note: Your member ID is the ID shown on your benefit identification card.