Submitting Claims
what you need to know
Submitting a claim or a request for reimbursement is easy. Make the most of your benefits by visiting an in-network provider. If you only have an out-of-network option, you may need to submit a claim form.
Medical Claims
When you go to your doctor or hospital, you’ll be asked for your medical insurance card. Your card tells your provider that you have medical coverage and what’s typically covered under your medical plan. It also lets your provider submit claims on your behalf.
Anthem Medical Plan Members
In general, after your provider submits a claim, Anthem will pay the provider directly (based on the type of plan you have and whether you’ve met your deductible or out-of-pocket maximum). Then, you’ll owe the balance. You’ll receive a bill from the provider for the amount you owe.
Your medical plan may also send you an Explanation of Benefits (EOB) — it’s basically a recap of the provider you saw, the services you had and how much was paid by your insurer. It’s not a bill though, and should say so on the first page.
If you need to submit a claim yourself, use the Anthem Claim Form. Questions? Contact your medical plan. Information is on the back of your ID card.
Kaiser Medical Plan Members
Your Kaiser medical plan will handle everything for you. In some cases, like if you need emergency care, you may need to submit the Kaiser Emergency Care Form. Questions? Contact your medical plan. Information is on the back of your ID card.
HSA Reimbursements
When you enroll in an HSA, you will receive an HSA Bank debit card to pay for eligible expenses within 10 to 14 days after your enrollment is processed. HSA Bank allows up to two free debit cards per account. You can also go to myaccounts.hsabank.com to set up your online account with HSA Bank.
If you have any questions, prior to your account being opened, contact the Client Assistance Center at HSA Bank at 1-800-357-6246. You will be asked to provide personal information such as your first and last name, date of birth, the last four digits of your Social Security number and your full address. Depending on the issue, you may also be asked to confirm your employer’s name (Hitachi America, Ltd.).
Once your account is opened, you can call our dedicated team at 1-844-650-8952 for further help.
Pharmacy Claims
When you visit a CVS Caremark network pharmacy, there are no claim forms to complete. Simply show your ID card and you will pay the corresponding coinsurance for your medication. If you paid out of pocket for a prescription and did not use your insurance, the quickest way to request reimbursement from your insurance plan is to visit the pharmacy where your prescription was filled, provide your insurance information, and ask for a refund.
You can also download and complete a Paper Claim Reimbursement form, located on the Print Plan Forms page of the CVS Caremark website. You must include the original prescription receipt. Once you complete the form, mail it to the address listed on the form. Be sure to make a copy of the completed form and prescription receipt and retain them for your records. Once the form is received by CVS Caremark, they will review the claim for processing.
Flexible Spending Account Claims
You have until March 31, 2025, to submit any claims incurred during the 2024 plan year (January 1 to December 31). Claims can be submitted through the Hitachi Benefit Pool website or the MyChoice mobile app. If you do not submit your claims by March 31, you will forfeit any remaining money in your account.
Dental Claims
When you visit dentists that participate in the MetLife Dental network, they will file claims with and accept payment from MetLife Dental so you don’t need to do anything.
If you choose to go to a dentist that is not in the MetLife Dental network, you will be responsible for paying the difference between what the plan covers and the amount your out-of-network dentist charges. Out-of-network dentists may require you to pay for services up front, which means you may have to file a claim for reimbursement through the plan.
Vision Claims
If you have vision coverage and receive in-network care, there are no claim forms to complete. If you receive care from out-of-network providers, you may need to pay for services up front and then file a claim to get reimbursed. You can also contact Member Services at 1-800-877-7195 for help submitting a claim or visit VSP for more information.
VSP does not provide a vision insurance cards. You’re covered either way, though—just tell your provider that you have VSP coverage, and they will look you up.
Weight Loss Program Reimbursement
Get help and support with weight-loss programs that are designed for you! Hitachi will reimburse you 50% of the cost of an eligible weight-loss program, up to $100 each year. Just complete an online expense report through Oracle iExpense, using the “US TE Template” — be sure the “purpose” reads “weight loss reimbursement.”
Smoking-Cessation Program Reimbursement
Trying to quit? It’s tough, but you’re not in this alone. Hitachi will support you by paying up to $300 each year for a qualified program. Kicking the habit is the tough part — getting reimbursed is easy. Just complete an online expense report through Oracle iExpense, using the “US TE Template” — be sure the “purpose” reads “smoking cessation.”
Questions?
1-844-318-3274Benefits Enrollment
Hitachi Benefit Pool Service Center
Mon–Fri, 7 a.m.–7 p.m. CT
Website
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