WCT/WTF COPAY/COINSURANCE REIMBURSEMENT 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 must follow the following easy steps.
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.
4. Request a “CLAIMS SUMMARY” for the calendar 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. They will NOT email it to you.
7. Send your “CLAIMS SUMMARY” along with your completed Co-Pay/Co-Insurance form to the address below.
Wappingers Congress of Teachers Welfare Trust Fund
c/o Daniel H. Cook Associates
253 West 35th – 12th Floor
New York, NY 10001