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Filing Claims

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Filing Claims

To obtain a claim form, visit the Voya Claims Center. You may submit your claim online at the Voya Claims Center, or you may submit your claim by mail or fax. 

To file your claim online, visit the Voya Claims Center.

  • For a critical illness claim, click the "Get Started" button under "Start A Claim" and follow the instructions.
  • For a wellness benefit claim, click the “Start Your Claim” button in the “Have a Wellness Benefit Claim?” section and follow the instructions.

Have the following information available:

  • The group number (CMSU's group number is 694924)
  • The name, date of birth, and Social Security Number of the patient and his or her relationship to you
  • Medical records confirming the diagnosis if a critical illness claim
  • Type of health screening, medical provider, and the test date if a wellness benefit claim

You must submit your claim to Voya within 30 days of receiving the critical illness diagnosis or health screening, or as soon thereafter as is reasonably possible.

Written proof of loss must be furnished to Voya within 90 days after the date of such loss. If it is not reasonably possible to provide such proof to Voya within this period, it must be done no later than one year after notice is required.

At their expense, Voya has the right and opportunity to require the claimant to be examined as it relates to the critical illness that is the basis of the claim. Voya can require such examination when and as often as they may reasonably require while the claim is pending. If you do not obtain the exam or provide information Voya requests to complete your claim, benefits may be denied. 

 

If Your Claim Is Denied

If your claim is denied, Voya will send you a written notice of the denial within 90 days after receipt of the claim. An extension of 90 days will be allowed for processing the claim if special circumstances are involved. The claimant will be given notice of any such extension. The notice will state the special circumstances involved and the date a decision is expected.

The notice of denial will be written in an understandable manner and include the following:

  • The specific reason(s) for the denial.
  • Specific reference to the provision which forms the basis of the denial.
  • A description of additional information, if any, which would enable a claimant to receive the benefits sought and an explanation of why it is needed.
  • An explanation of the claim review procedure, including the time limits applicable to such procedures and notice of the claimant’s right to bring a civil action pursuant to Section 502(a) of ERISA following an adverse decision on appeal.

 

Appeal Procedures

You have 60 days from the date you receive notice of a denied claim to file an appeal for that claim. Send your written appeal to the address specified in the claim denial. 

Voya will consider requests for an appeal of a denied claim upon written application of the claimant or his or her duly authorized representative. As part of the appeal, the claimant has the right, upon request and free of charge, to access or obtain copies of all documents, records and other information that is relevant to the claim for benefits. The claimant may, in the course of this appeal, submit to Voya written comments, documents, records, and other information relating to the claim. Voya will provide a full and fair review that takes into account all comments, documents, records and other information submitted by the claimant without regard to whether such information was submitted or considered in the initial benefit determination. Review of claim denials and final decisions on appeal are the responsibility of Voya.

Voya will provide the claimant with a written decision of the final determination of the claim. This decision will be written in an understandable way, state the specific reason(s) for the decision, and make specific reference to the provision(s) on which the decision is based. This decision will be issued as soon as practicable from the date of appeal, but not longer than 60 days unless an extension is needed. An extension of 60 days will be allowed for making this decision if special circumstances are present. The claimant will be given notice if this extension is necessary. If the decision on review is not received within these time limits, the claim may be considered denied. If the claimant receives an adverse benefit determination, the claimant will then have the right to bring a civil action pursuant to Section 502(a) of ERISA.

Voya has final discretionary authority to determine all questions of eligibility and status, to interpret and construe the terms of this policy(ies) of insurance, and to make claim determinations.