Your General Medical Reimbursement Benefit What Is The General Medical Reimbursement Benefit?
When Is Coverage Provided ?
What Expenses Are Covered By The General Medical Reimbursement Benefits?
Getting Your Benefit
What Is The General Medical Reimbursement Benefit?
The Fund will provide you, your spouse and eligible children up to a maximum benefit of $150 per family, per calendar year for certain unreimbursed medical expenses. You can apply the reimbursement toward un-reimbursed, out-of-pocket medical expenses, health plan premium payments, deductibles and co-payments under any medical insurance covering you, your spouse and your eligible dependents. This benefit is for reimbursement of medical expenses only. Mental health, podiatry, dental and optical expenses are not eligible for reimbursement under this benefit.
When Is Coverage Provided?
Coverage is provided when:
- Services are received in accordance with the procedures described in this Summary Plan Description.
- Services are obtained while you, your spouse or your children are eligible for coverage (See the section entitled “Eligibility”).
- Services are medically necessary.
- Services are not otherwise excluded.
What Expenses Are Covered By the General Medical Reimbursement Benefit?
The Fund will reimburse your out-of-pocket expenses, not otherwise reimbursed under any plan of insurance or other benefit plan provided by this Fund, up to the maximum annual family limit, for:
- Unreimbursed premium payments, deductibles and co-payments under any medical insurance plan covering you, your spouse and eligible children.
Getting Your Benefit
Follow these simple steps:
If you are submitting claims for unreimbursed premium payments, deductibles or co-payments under your City Health Plan or any other medical plan covering you, your spouse and your eligible children:
Claims submitted after that date will be denied.
- Save your health plan statements showing that you have met your deductibles, co-payment expenses, and incurred premium payments for which you have not been reimbursed and had co-payment expenses for covered medical procedures.
- Obtain a claim form from the Fund Office.
- Submit photocopies of your health plan statements to the Fund Office once each calendar year no later than June 30th following the end of the prior year.