Benefits are provided for member, spouse and eligible dependents. All Medical Supplemental Benefits are secondary to your or your spouse’s health plan.
1. Foot Orthotics
The Fund will reimburse up to $250.00 per individual covered for unreimbursed expenses for foot orthotics if necessary as determined by your health insurance provider. Reimbursement will be allowed every 12 months for covered individual under age 18 and every 24 months for covered individuals over age 18.
2. Durable Medical Equipment
The Fund will reimburse up to $500.00 per year per covered individuals for unreimbursed expenses for durable medical equipment.
3. Ambulance Service
The Fund will reimburse up to $250.00 per year per covered individuals for unreimbursed expenses for ambulance service.
4. Hearing Aid Benefit
The Fund will reimburse up to $400.00 per ear toward the purchase of a qualified hearing aid device once every 36 months for each covered individuals.
In addition, the Fund will reimburse up to $50.00 per year toward maintenance (including batteries) of a hearing aid device.
In order to be reimbursed for the above listed benefits you must first submit to your health care provider. After payment is made by them you must then submit the explanation of benefits from your health provider along with your receipt(s) for payment to the Fund Office.
5. Prescription Drug Benefit
Prescription drug benefits are provided for you and your eligible dependents for the out-of-pocket expenses for prescription drugs incurred during a calendar year at the rate of $60.00 per prescription up to the annual maximum of $800.00 and then $2.00 for each additional precription. The following types of prescriptions are covered if prescribed by a licensed medical doctor, dentist, psychiatrist or osteopathic physician and dispensed by a licensed pharmacy.
- Prescriptions for legend drugs (drugs which cannot be dispensed by a pharmacy without a prescription).
- Prescriptions which require compounding.
- All series of insulin
- Companion implements for insulin, such as hypodermic syringes, needles, etc, will also be covered under this benefit if you have not met the annual maximum for this benefit. Please provide health care provider E.O.B.
No benefits are provided for the following, even if prescribed by a doctor:
- Over-the-Counter drugs and cough medicines.
- Diet Supplements.
- Drugs prescribed for a cosmetic purpose.
HOW TO OBTAIN THE BENEFIT
If you are covered by Employee Medical Health Plan of Suffolk County (EMHP) wait until you receive the Explanation of Benefits (EOB) from the EMHP’s Prescription Benefits Manager, Express Scripts which is mailed to you automatically, after completion of the calendar year. If there are prescriptions received but not listed on the E.O.B., submit a printout from your pharmacy.
If you are not covered by E.M.H.P., submit a computer printout from the pharmacy from which you receive your prescriptions.
Note: The Fund does not require the names of the drugs you and your covered dependents purchased to process a claim. If you and your covered dependents are covered by the EMHP, you may submit a copy of your Explanation of Prescription Drug Benefits (“EOPB”) for the calendar year showing only the out-of-pocket cost for prescription drugs for you and your covered dependents. If you and your covered dependents are not covered by the EMHP, you may submit a computer printout from the pharmacy where you and your covered dependents purchased prescription drugs showing only the out-of-pocket cost for prescription drugs for you and your covered dependents
Prescription drug claims will only be accepted between February 1st and April 30th of the following year in which the prescriptions were dispensed. The Fund will process only one claim per family per year.
6. Medical Co-pay Reimbursement Benefit
A new pilot program will reimburse up to $20 per medical office visit with an annual maxmum benefit of $200 per covered family, plus an additional $1.00 per each medical office visit once the annual maximum benefit has been reached.
HOW TO OBTAIN THE BENEFIT
Medical co-pay claims will only be accepted between July 1st and August 31st of the following year in which the co-pay was generated. The Fund will process only one claim per family per year.