Who is eligible?
Prescription copay reimbursement benefit program is available to all active and retired members and their dependents covered by the Fund, who participate in the Empire Healthy Advantage PPO and EPO Select 20 Plans, provided by the Dutchess Educational Health Insurance Consortium ("DEHIC".) Members are eligible once they enroll for trust fund benefits and they must work at least 17.5 hours per week. Retirees must also be enrolled in the Enhanced or Enhanced Plus Plans to be eligible for this reimbursement. Download a reimbursement form below.
What is the benefit?
Once annually, up to a maximum of $200 plus $5.00 for every prescription after the initial $200 is met, the Fund reimburses the member the co-payment costs which have been paid within the calendar year for drugs prescribed by a medical doctor, osteopath or dentist. Prescriptions must be dispensed by a licensed pharmacist. Prescription services which are covered included are those eligible under your primary prescription plan.
What is not covered?
There is only one claim per family per calendar year. Individual prescriptions must be accompanied by pharmacy printout or copy of receipt. Do not submit original receipts because the Fund is not responsible for loss if originals are submitted.
When to file a claim?
You may put in your claim as soon as you reach your maximum $200 plus $5.00 for every prescription after the initial $200. is met, or at any time at the end of the calendar year for your total that may be less than $200.
How to file a claim?
It has come to our attention that Express Scripts has been giving inconsistent information to members when requesting their statement of benefits. We have reached out to Empire BC/BS to address this issue. To avoid further confusion, you no longer need to call Express Scripts at all. With one call to Empire (1-844-588-1714), you can request both your medical (co-pay/co-insurance) and your pharmacy statements. Your pharmacy statements will include Express Scripts and ALL other pharmacies that you use. Your pharmacy statement can also be downloaded from the Empire website using the same directions to download your co-pay/co-insurance statements.
1. Print the PRESCRIPTION REIMBURSEMENT form under the FORMS TO DOWNLOAD tab on the WCT website. (Just scroll down on this page, you will see the pdf. It's the same one that we've been using since 2016).
2. Call or go in person to your pharmacy and ask for a list of prescriptions for the 2018 calendar year.
3. Call EMPIRE BLUE CROSS/BLUESHIELD at 1-844-588-1714.
You may request both your Medical (Co-pay/Co-insurance) AND your pharmacy statements. Your pharmacy statement will include Express Scripts and ALL other pharmacies that you use.
HOW TO SUBMIT YOUR PRESCRIPTION REIMBURSEMENT FORMS
*** YOU MAY SUBMIT YOUR FORMS VIA REGULAR MAIL OR FAX ***
Mail summaries AND forms to: WCT Welfare Trust Fund c/o Daniel Cook Associates
253 West 35th Street 12th Floor
New York NY 10001
Fax summaries AND forms to: 1-646-381-8866 (this is a dedicated fax line for WCT)
The same rules and regulations governing your primary prescription drug plan apply. The Fund does not cover prescription costs incurred by members beyond the amount payable by your primary prescription drug plan. If for some reason you had to pay full price for a prescription (perhaps your card was unavailable, or you were out-of-state), you MUST first submit the costs to your primary prescription plan prior to claiming. Do not submit your claim to the Fund unless all costs are backed by proof. Submissions at a later date will NOT be reconsidered for payment.