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How to File a Claim for Benefits

Disability and In-Hospital claims must be filed within 1 year of the date the disability or in-hospital confinement began, except in the absence of legal capacity, in order for the claim to be considered for benefits. It is recommended that you contact the SAMBA Customer Service department, 1-800-638-6589, to assist you with the claim filing process.

 

Disability Claim:

A disability claim may be filed if you sustain an injury or illness that will prevent you from performing the material and substantial duties of your regular occupation for more than 60 consecutive days.

 

You, your providers and your agency will need to complete different portions of the contents of the Claim Packet.  All documentation is to be returned to SAMBA from each of the respective individuals required to provide documentation.

 

In-Hospital Claim:

To file an In-Hospital claim for you, your spouse or unmarried child, less than age 22, you will need to submit a copy of the hospital’s UB04 statement.  The UB04 is a summary of the charges incurred.

Available only to full-time active federal employees.