HEALTH INSURANCE CO-PAY
Who is Eligible:
· Full time employees
· Retirees
· Eligible dependents
Benefit Defined: The Fund will reimburse the full cost of out of pocket co-pay expenses for physician and chiropractor office visits and laboratory co-pay expenses to a maximum of $150 per family (employee and his/her eligible dependents) per year. The co-pay benefits for Medicare eligible retirees also includes non-reimbursable Medicare expenses.
Filing Requirements: Claims can only be submitted once per year, either when the maximum $150 has been met or, if less than $150, after January 1st following the year in which the expenses were incurred, but not later than March 31st. No claim will be honored if postmarked after the March 31st following the year in which the expenses were incurred.
Exclusions and Limitations:
1. This benefit does not apply to costs covered or reimbursed by your or your spouse’s health insurance or other similar benefit plan.
2. Non-physician providers, physical therapy, emergency room services, procedures performed at a hospital, x-rays and dental co-payments are not eligible.
3. Deductible and co-insurance payments are not eligible.
4. Co-pay expenses in excess of the calendar year maximum.
5. EFFECTIVE 2005: if a husband and wife are both full time eligible employees and/or retirees, the Fund will pay a maximum of $300 per family (employee and his/her eligible dependents) in any calendar year; however, no more than $150 may be submitted for expenses incurred for any one person per calendar year.
6. If the husband and wife are both eligible employees and/or retirees, the claims must be submitted together.
Health Insurance Co-Pay/Pescription Reimbursement