If you are a qualified participant in the Public Safety/CORP Cancer Insurance Policy Program (CIP), any claim for benefits must be submitted through our office by completing and returning the Public Safety/CORP Cancer Insurance Policy Program INITIAL Claim Form PACKET. This PACKET includes the INITIAL Claim Form, Arizona state and Federal income tax withholding forms, Attending Physician Statement, and List of All Prescribed Medication, which are required to be completed by each doctor/physician who is currently treating you for your cancer. Additionally, it is REQUIRED that we receive a PATHOLOGY REPORT confirming the diagnosis.
All forms are located in the Forms & Resources section under Cancer Insurance & HIPAA Forms.
Please ensure that all sections of the forms are complete and that you and your physician(s) have signed in the appropriate areas. The completed INITIAL Claim Form PACKET may be returned to our office either by mail, fax, or email and you should receive a response from our office in approximately 2-4 weeks on the status of your claim.
If you are submitting another claim, you will need to complete the Public Safety/CORP Cancer Insurance Policy Program SUPPLEMENTAL Claim Form and the PSPRS and CORP Cancer Insurance Pharmacy Benefits Claim Form, as applicable, and are located in the Forms & Resources section under Cancer Insurance & HIPAA Forms. To avoid any delays in the processing of your claim, ensure that all areas are complete and signatures are collected before submitting to our office either by mail, fax, or email.
For a full listing of the terms of the plan, along with the Schedule of Benefits, which provides the Benefit Provisions, Amounts and Limits, refer to the PS and CO Plan Descriptions.
Payment of Claims
Following the determination of approved claims for diagnosis of cancer and skin cancer, these claims will be paid directly to your employer (or former employer) and then your employer will subsequently process the payment through their payroll system, less Arizona state and Federal income tax withholding you elected at the time of your initial claim. All other approved claims will be paid directly to you from our office.