Who is eligible?
Members claiming for self and participating dependents. Members are eligible once they enroll for trust fund benefits, they must work at least 17.5 hours per week. Retirees who have enrolled in the Enhanced or Enhanced Plus Plans are 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?
Obtain a prescription co-payment reimbursement claim form from the Fund office. Pharmacy drug printouts may be attached to the claim form in lieu of filling out individual prescription lines proving that the patient's name, date of purchase, prescription number, name of drug, prescription doctor's name, dispensing pharmacy and the cost, or co-payment amount of the prescription to the patient is entered. The co-payment amount must be indicated either on the claim form or pharmacy print-out. All claim forms MUST contain a total dollar amount of the bottom of the claim or it will be returned to you without payment. All items listed will be subject to verification. Your prescription drug claim MUST be submitted in the first quarter following the year charges were made in order to be eligible for coverage.
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.