As a member of the PEBP CDHP, you have the right to voice complaints about the plan or submit appeals. You have the right to ask the Plan Administrator or its designees to reconsider a determination resulting in a denial (in whole or in part) for a service or treatment, or rescission of coverage (retroactive cancellation).

The CDHP Master Plan Document provides information regarding the terms, conditions, and administration of the benefits provided to participants. Beginning on page 100 of the document, information is provided on how a participant can appeal a decision made by either the PEBP Staff or the PEBP claims administrator(s).

Once you have received an (EOB) from Healthscope denying coverage, you will have 180 days to submit an appeal to the claims administrator. Appeals must be submitted in writing and should include the following:

  • The name and social security number, or member identification number, of the Participant;
  • A copy of the EOB and claim; and
  • A detailed written explanation why the claim is being appealed.
  • Information is mailed to the Claims Administrator:

    P.O. Box 91603
    Lubbock, TX 79490-1603

    Express Scripts
    P.O. Box 66566
    St. Louis, MO 63166-6566

Failure to request a review in a timely manner will be deemed to be a waiver of any further right of review of appeal under the Plan unless the Plan Administrator determines that the failure was acceptable.

For a list of frequently asked questions, please refer to our FAQ.

Additional Resources

  • PEBP’s e-portal site provides access to your information related to eligibility, claims, medical cost look up tool, HSA/HRA balances, provider look up, prescription drug pricing, and ID cards.

  • Third Party Administrator for CDHP participants, PPO Dental Plan, Health Savings Account and Health Reimbursement Account.

    P.O. Box 91603
    Lubbock, TX 79490-1603

    888-7NEVADA (888-763-8232)

  • P.O. Box 66566
    St. Louis, MO 63166-6566

    Customer Service: 855-889-7708

    Benefits and Prescriptions: 800-282-2881

  • Administrator for the CDHP participants who need pre-certification for services (e.g. In-patient hospital admissions and certain outpatient procedures), and large case management (e.g. Complex disease and/or high cost disease management).

    Pre-certification: 1-888-323-1461
    Case Management: 1-800-641-3224