Coinsurance/Co-Payment Reimbursement Benefit Program Update (June 2016)
The Coinsurance/co-payment 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”).
What is covered?
The Fund will reimburse up to $300 per covered family for any in-network coinsurance and/or co-payment costs incurred under the DEHIC Empire Blue Cross Blue Shield Healthy Advantage PPO and EPO Select 20 Plans. Once the $300 is reached, the Fund will reimburse 1% of all additional in-network coinsurance and/or co-payment costs incurred during the same period.
When to file a claim?
Your claim must be submitted during the first quarter of the calendar year following the calendar year during which your coinsurance and/or co-payment expenses were incurred.
How to file a claim?
Obtain a coinsurance/co-payment reimbursement benefit claim form from the Fund office or the WCT website – www.wcteachers.org. You must also obtain a claims summary from Blue Cross Blue Shield for your expenses for the claim period and attach it to your claim form. All claim forms must contain a total dollar amount including the 1% at the bottom otherwise it will be returned to you without payment.
In order to take advantage of this benefit, you can do one of the following options.
OPTION 1 – MAKE A CALL
1. Print the Co-pay/Coinsurance form under the FORMS TO DOWNLOAD tab on the WCT website
2. Complete the top portion of the form, sign, date, and enter total amount submitted.
3. Call Empire at 1-800-342-9816 (this number is on the back of your insurance card). Ask to speak with a customer representative. Follow steps 4-6.
4. Request a “CLAIMS SUMMARY” for the calendar 2018 year.
5. You will only be able to request a “CLAIMS SUMMARY” for you and any dependents under the age of eighteen. Other family members that are covered under your insurance will need to request their own “CLAIMS SUMMARY”. This is necessary due to HIPAA privacy regulations. This request can take place during the same phone call.
6. They will send your “CLAIMS SUMMARY” via standard mail. You may request your information be sent via email, however, you must send them an email requesting the summary. They will tell you what email to send it to.
OPTION 2 – LOGIN TO YOUR EMPIRE BLUE ACCOUNT
- Click “MY PLAN” – Click “CLAIMS” from the dropdown menu
- Click “REFINE RESULTS”
- DATE RANGE – Enter 01/01/18 through 12/31/18
- CLAIM TYPE – Medical
- PATIENT – All
- Go back to the top of the page – Click “DOWNLOAD RESULTS”
- Click the MICROSOFT EXCEL option
- Print the summary to either send via mail or fax.
HOW TO SUBMIT CO-PAY – CO-INSURANCE 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 for the WCT)