- Claims move through submitted, under review, approved, rejected, paid, partially paid, appealed, reversed, or disputed states according to group rules and evidence.
- Claimants must submit truthful evidence and must have authority to provide beneficiary, medical, family, or other sensitive data. Sensitive data should be limited to what the claim process actually requires.
- Officers must review eligibility, waiting periods, arrears, documents, beneficiary details, reserve impact, fraud flags, conflicts, and payout affordability before approval.
- Payouts may be delayed, partial, rejected, reversed, or unavailable because of group rules, insufficient group funds, payment-provider delays, wrong beneficiary details, fraud concerns, or legal restrictions.
- FelbaCare is not an insurer and does not guarantee claim approval, payout, timing, group solvency, or recovery from a dishonest officer or member.
Claims and Payout Terms
Claim eligibility, evidence, beneficiary details, approvals, payout limits, appeals, and fraud handling.