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Providing customers with what they need

We are here for you

That’s why your employer chose FCE. We are the trusted experts in the administration of Health & Welfare benefits globally.

FCE Benefits’ team of customer service professionals are committed to providing you with the level of support you deserve. Our well trained bi-lingual staff is prepared to provide prompt and thoughtful assistance. We focus on addressing your unique needs. That’s how FCE Benefits differentiates itself in the marketplace. We care.

Claim Forms & Documents

Get the forms you need to file your claims.
Learn More

Explanation of Benefits (EOB)

Introducing The new 21 day, Episodic EOB®
Learn More

ID Card
Request

Your ID card is
available for Download
Learn More

Health Plan
Transparency Files

Download Health Plan
Transparency files
Learn More

Claim Forms & Documents

FCE provides a wide variety of Claims Administration services

The following claims forms are available for download for FCE administered benefits (Note: these forms can be completed online. Simply place your cursor in the space provided and start typing. Press the Tab Key to the progress through the document. Then, print out the form, sign, and return to us using one of the means below):

Claims Mailing Address:

Hard copies of claims may be mailed to the following address for processing
FCE Benefit Administrators, Inc.
PO Box 211757
Eagan, MN 55121

Claims & Forms

Medical Claim

For submitting medical claims
Prescriptions Claim

For reimbursement of covered prescription drug claims.
PT Mini-Claim Form

For Part-timers to submit with EOB or visit summary
Vision Claim

For reimbursement of covered vision care claims.
Eyemed Vision Claim

For Out of Network Vision Services Claim Form
FCE Short-Term Disability

Short-Term disability claim form
RSL Short-Term Disability

Short-Term Disability Benefits Initial Statement of Claim for Reliance Standard

RSL Life Insurance

Life Insurance Claim for Reliance Standard

Flexible Spending Account (FSA)

For reimbursement of FSA expenses
Health Reimbursement Arrangement (HRA)

For reimbursement of HRA expenses
Commuter Benefit Claim Form

For reimbursement of Commuter (Parking and/or Transit) expenses

Life and AD&D Conversion Forms

Please reference your summary plan description to determine which Life or AD&D conversion form applies to you.

RSL Group Life Conversion Application

To convert this Group Life insurance to an Individual policy
CIGNA (LINA) Life Conversion Application

To convert this Group Life insurance to an Individual policy
MetLife Life Conversion Application

To convert this Group Life insurance to an Individual policy
New York Group Life Conversion Application

To convert this Group Life insurance to an Individual policy
UNUM Life Conversion Application

To convert this Group Life insurance to an Individual policy
Group AD&D Conversion Application

To convert this Group AD&D insurance to an Individual policy

Flyers and Resources

Part-Time Medical Benefits Flyer

Information for part-timers with and without insurance

Explanation of Benefits (EOB)

FCE is now using an Episodic Explanation of Benefits Statement (EOB), based on a 21-day business cycle.

The new Episodic EOB® is environmentally friendly; it consolidates multiple EOBs for a single member every 21 business days into one document or episode of care.

An EOB is not a medical bill. It is an itemized statement summarizing a great deal of information, such as:

  • The type of healthcare service received
  • The amount billed for the healthcare service
  • How much was paid to the provider
  • The balance owed by the member

Sample EOB

  1. Invoice Information: EDI Payer number used for electronic claims submission and Employer name and Statement Date.
  2. Time Period: Claims processed during date range.
  3. Total Billed Amount: What the health care provider charged for the services listed.
  4. Total Amount Paid By Plan: The amount the Plan paid to the healthcare provider, which may be less than what the healthcare provider charged.
  5. Your Financial Responsibility: The remaining total amount you are responsible for payable to your healthcare provider.
  6. Patient and Participant -
    • Participant Name & ID: The ID is the last four digits of the employee social security number
    • Participant Number: The FCE generated identification number assigned to the claim.
    • Service Provider: The health care professional who is indicated on the claim as having provided the service.
    • Claim Number: The FCE generated identification number assigned to the claim submitted by your provider.
  7. Type of Service: A brief description of what services were provided on the dates listed.
  8. Service Dates: The date services were rendered to patient listed.
  9. Discount Amount: Amount of charge after network contract/allowed amount (if any).
  10. Ineligible Amount: The amount deemed non-covered by your plan.
  11. Allowed Amount: Amount of the charge that was allowed according to plan specifications or network discount.
  12. Copay: Amount for a covered service, paid by a patient to the provider of service before receiving the service.
  13. Deductible: A cost-sharing feature of your plan where you pay for some healthcare services up to a specified amount before the Plan begins to pay.
  14. Other Ins. Pay: Amount of payment from another insurance policy.
  15. Co-Insurance: A cost-sharing feature of your plan where you and the Plan pay a percentage of the covered services.
  16. Co-Insurance %: The percentage of payment the Plan is responsible for.
  17. Accumulators: The amount of patient responsibility accumulated to your deductible and out of pocket maximums.
  18. Remark Code Description: The line item explanation, if needed, on how the claim was processed.
EOB Example

ID Card Request

Replacing your ID Card is quick and easy.

Did you lose your ID card? Has your permanent card not come in yet? Do you need an extra card? You can always download a temporary card from the FCE website. It’s quick and easy.

For Instant Access

To download a card, simply go to the LOGIN to get started.

To Request A Card Be Sent

You may request a replacement ID card be mailed to you by contacting Customer Care at (800) 298-7269. Customer service professionals are available Monday through Friday, 8:00 am to 7:00 pm CST. Spanish speaking representatives are available.

Health Plan Transparency Files

Download Health plan transparency files

This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

Please note that CIGNA provides the machine-readable files for your Plan. This link leads to the machine-readable files that are made available pursuant to the Federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers.

For more details on the Transparency in Coverage Rule, review the information at these links:

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