Postal Members:
Claims & Billing Explained
Navigating Your Health Benefits with Confidence
As a valued member of the NALC Health Benefit Plan for postal employees and retirees, we're committed to helping you understand and use your benefits with clarity. Whether you’re enrolled in the High Option or Consumer-Driven Health Plan (CDHP), this page walks you through your claims, billing details, and key protections under your Postal Service Health Benefits (PSHB) plan.
High Option Plan
Call us at:
High Option: 888-636-NALC (6252)
CDHP: 855-511-1893
Consumer-Driven Health Plan (CDHP)
For Claim Status or Claim Related Questions
Call us at:
High Option: 888-636-NALC (6252)
CDHP: 855-511-1893
Your Rights Against
Surprise Medical Bills
When you receive medical care—especially in emergencies—you may not be able to choose your provider. If that provider is out-of-network, you could receive a "balance bill"—meaning you’re charged the difference between the provider's fee and what the Plan pays. This is often referred to as surprise billing.
Your Protections as a Member
The No Surprise Act protects our members from these unexpected costs in key situations:
- Emergency services received from an out-of-network hospital or provider.
- Certain non-emergency services received at an in-network hospital or ambulatory surgical center when an out-of-network provider is involved (for example, an anesthesiologist during surgery).
- In these cases, you only pay your normal in-network cost-sharing (copays, coinsurance, deductibles).
What You’re Still Responsible For
- Paying your usual copay, coinsurance, or deductible as if the provider were in-network.
- Checking if your provider or facility is in-network whenever possible, to avoid confusion in situations not covered by these protections.
These payments will count toward your out-of-pocket maximums—just like in-network care.
What Providers Can’t Do
- They can’t bill you more than your in-network share for emergency and certain hospital-based services.
- They can’t ask you to waive your rights under the No Surprises Act.
- They must bill you accurately, based on your plan’s network agreements.
What You Can Do if You Receive a Surprise Bill
- Don’t pay right away.
- Contact NALC HBP at 📞 888-636-NALC (6252) for help reviewing the bill.
- File a complaint with the federal No Surprises Helpdesk at 📞 1-800-985-3059.
FAQs for Postal Employees —Claims & Billing
We’re here to make things simple. Find answers to the most common claims & billing questions.
A claim is a request for payment that your doctor, hospital, or you submit to the plan after you receive care. It tells the plan what services were provided and what should be covered.
If you see an in-network provider, they usually file claims for you. If you visit an out-of-network provider or get care overseas, you may need to submit the claim yourself.
The plan reviews the claim, processes payment to the provider or to you, and sends you an Explanation of Benefits (EOB) showing what was covered and what you may still owe.
You’ll receive an explanation of benefits (EOB) explaining the reason for the denial. You have the right to appeal, and instructions for appeals are included with the EOB.