Skip Links
Back to Previous Page
Committee Contacts
Scott Bowles
Chair
Scott.Bowles@alpa.org
Jon Erickson
Vice-Chair
Jon.Erickson@alpa.org
Submit a R&I Issue
*Required Fields
Empno
Go
Name
Category
*Phone
*Email
*Plan
Medical
Dental
Pharmacy
Vision
*Plan Type
Diamond HSA
DPM
DPM Out of Area
Gold HRA
Gold HRA Out of Area
PPO Option B
Ruby HSA
Silver HRA
*Issue
Select Issue
Appeals
Behavior/Mental Health
Coinsurance
Copay
Deductible
Denial of coverage
Dependent coverage
Eligibility Issue
FSA/Limited Purpose FSA
Lack of network coverage
Other
Out of pocket limit
Premium Amount
Preventive
Reimbursement Rate
*Explain
Date of Service
EOB Claim No.
EOB Remark Code
*Message
I contacted UHC/Met Life Dental/Medco?
Yes
No
Has issue been resolved?
Yes
No
Check to receive a copy of your submission