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JNT 8/13 P.O. BOX 4346 • MISSOULA MT 59806 (406) 721-2222 or (877) 424-3570 Fax: (406) 523-3149 or (877) 424-3539 www.allegianceflexadvantage.com Joint Processing YOU HAVE A CHOICE ♦ ♦ ♦ This option must be elected each plan year ♦ ♦ ♦ Joint Processing is a service for those clients who have a Health Plan and a Flex Plan administered by Allegiance Benefit Plan Management, Inc. When you are a part of Joint Processing, you receive your funds from Flex automatically. You do not have to wait to receive your Explanation of Benefits (EOB) from the Health Plan, make copies of the EOB and then send the EOB back to Allegiance Benefit Plan Management, Inc. with a claim form to wait for your Flex reimbursement. BUT, Joint Processing is not for everyone! If you have a secondary insurance for anyone in your family who is also covered on your Employer's Health Plan, you should not be on Joint Processing. You must first submit claims to both insurance carriers, then send copies of the EOB’s from both carriers to the Flex Plan using a claim form. Or you may want to choose which claims to submit to your Flex Plan and in what time frame. YES, include me in Joint Processing. Neither I nor other covered members of my family have a secondary insurance. * Effective date of this election NO, do not include me in Joint Processing. I will submit all claims. COMPANY NAME PRINTED NAME PARTICIPANT ID NUMBER EMPLOYEE SIGNATURE DATE * Joint Processing can be implemented retroactively. Please indicate the date you want to enroll.