For IPF:
Phone: 1-888-880-8222
Fax: 202-347-7339

For IHF:
Phone: 1-888-880-8222
Fax: 202-383-3905

620 F Street, NW
Washington, DC 20004

About Us

Summary Plan Description

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Silver Plan (PDF)

Bronze Plan (PDF)

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HIPAA Privacy Notice
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How to File an IHF Claim

This section provides you with information about:
How and when to file a claim.
If you receive Covered Health Services from a Network provider, you do not have to file a claim. Network providers are responsible for filing claims. We pay these providers directly.
If you receive Covered Health Services from a non-Network provider, you are responsible for filing a claim.

If you received covered health services from a network provider

We pay Network providers directly for your Covered Health Services. If a Network provider bills you for any covered health service, contact the Claims Administrator. However, you are responsible for meeting any annual deductible and any copayments to a Network provider at the time of service, or when you receive a bill from the provider.

Filing a claim for benefits

When you receive Covered Health Services from a non-Network provider as a result of an Emergency or if we refer you to a non-Network provider, you are responsible for requesting payment from us through the Claims Administrator. You must file the claim in a format that contains all of the information required, as described below.

You must submit a request for payment of Benefits within one year after the date of service. If a non-Network provider submits a claim on your behalf, you will be responsible for the timeliness of the submission. If you don't provide this information to us within one year of the date of service, benefits for that health service will be denied or reduced, in the Plan Administrator's or the Claims Administrator's discretion. This time limit does not apply if you are legally incapacitated. If your claim relates to an Inpatient Stay, the date of service is the date your Inpatient Stay ends.

If a participant or employee provides written authorization to allow direct payment to a provider, all or portion of any Eligible Expenses due to a provider may be paid directly to the provider instead of being paid to the participant or employee. We will not reimburse third parties who have purchased or been assigned benefits by Physicians or other providers.

Required Information

When you request payment of Benefits from us, you must provide us with all of the following information:

Participant name and address
The patient's name, age and relationship to the participant
The member number stated on your ID card and Group number
An itemized bill from your provider that includes the following:
  1. patient diagnosis
  2. place of service
  3. date(s) of service(s)
  4. procedure code(s) and descriptions of service(s) rendered
  5. charge for each service rendered
  6. provider of service name, address and tax identification number
The date the injury or sickness began
A statement indicating either that you are, or you are not, enrolled for coverage under any other health insurance plan or program. If you are enrolled for other coverage you must include the name of the other carrier(s).

Payment of Benefits

Through the Claims Administrator, we will make a benefit determination as set forth below. Benefits will be paid to you unless either of the following is true:

The provider notifies the Claims Administrator that your signature is on file, assigning benefits directly to that provider.
You make a written request for the non-Network provider to be paid directly at the time you submit your claim.