Information Needed and Whom to Contact
Plan Administrator
Arizona Local Government
1115 Stockton Hill Rd., Suite 101
Kingman, AZ 86401
1-928-391-2298
Medical Claims Administrator/Third Party Administrator
(Medical, Short-Term Disability, and Dialysis)
Request Medical ID Card
Claim Forms (Medical)
Medical Claims and Appeals
Eligibility for Coverage
Plan Benefit Information
AmeriBen
P.O. Box 7186
Boise, ID 83707
Phone: 1-877-635-2912
www.MyAmeriBen.com
Medical Management Administrator
Pre-Certification, Concurrent Review, and Case Management
Appeals of Pre-Certification
American Health Group (AHG)
2152 South Vineyard, #103
Mesa, AZ 85210
Phone: 1-800-847-7605
www.amhealthgroup.com
PPO Provider Network
Names of Physicians
& Hospitals
Network Provider Directory – see website
Blue Cross Blue Shield of Arizona
Phone: 1-877-635-2912
www.azblue.com/chsnetwork
Wellness Program
Health Screening Questions
Wellness Challenge Questions
Vitality Portal Questions
Livongo Questions
Diabetes Management
Pre-diabetes and Weight Management
Hypertension Management
Telemedicine
AZLGEBT Enrollment Portal
Names of Physicians
& Hospitals
Qualifying Life Event Changes
Annual Benefit Elections
Update Demographic Information
SmartBen
https://azlgebt.smartben.net
Prescription Drug Program
Retail Network Pharmacies
Mail Order (Home Delivery) Pharmacy
Prescription Drug Information & Formulary
Preauthorization of Certain Drugs
Reimbursement for Non-preferred Retail Pharmacy Use
Specialty Pharmacy Program
Retail/Mail Order
Navitus Health Solutions
Appleton, WI 54912-0999
Phone: 1-480-498-6268
www.navitus.com
Specialty Pharmacy
Navitus Specialty Rx
Madison, WI 53717
Phone: 1-855-847-3553
www.lumicera.com
Employee Assistance Program (EAP)
EAP Counseling and Referral Services
Mental Health/Substance Abuse Pre-Certification
Jorgensen Brooks Group
Phone: 1-888-520-5400
www.jorgensenbrooks.com
COBRA Administrator
Continuation Coverage
AmeriBen
P.O. Box 7565
Boise, ID 83707
Phone: (877) 635-2912
Fax: (208) 424-0595
Health Savings Account (HSA)/Flexible Spending Account (FSA) Administrator
Request Debit Card
Claim Forms
Balance Inquiries
HealthEquity
Phone: (630) 673-2413
www.healthequity.com
Dental Claims Administrator / Third Party Administrator
Request Dental ID Card
Claim Forms
Claims and Appeals
Eligibility for Coverage
Plan Benefit Information
Ameritas Group
5900 O Street
Lincoln, NE 68510
Phone: 1-800-487-5553
www.ameritasgroup.com
Vision Claims Administrator / Third Party Administrator
Request Dental ID Card
Claim Forms
Claims and Appeals
Eligibility for Coverage
Plan Benefit Information
Ameritas Group/VSP
5900 O Street
Lincoln, NE 68510
Phone: 1-800-487-5553
www.ameritasgroup.com
Life Carrier
Group Basic Life
Voluntary Term Life
Waiver of Premium
Portability Information
Conversion Information
Death Claims
Securian Financial/Ochs, Inc.
400 Robert Street North
St. Paul, MN 55101
Phone: 1-800-392-7295
www.ochsinc.com