Don’t miss your co-payment reimbursement deadline! The CSEA Employee Benefit Fund (EBF) offers varying prescription drug and physician co-payment reimbursements that may have been negotiated into your collective bargaining agreement. These benefits reimburse you once annually for co-payments spent per calendar year. The deadline for the 2013 calendar year is March 31, 2014. You can get your claim form by visiting EBF’s website at www.cseaebf.com and following the Download Forms link. No username or password is required to enter the site. If you are eligible, complete and submit the applicable claim form along with supporting documentation by March 31, 2014. For prescription drug copayment reimbursements, you must attach an itemized pharmacy printout. For physician co-payment reimbursements, attach an Explanation of Benefits (EOB) from your health insurance carrier. Here is an overview of the required claim forms: Prescription Drug Co-Payment Reimbursement Form for New York State Employees Members who are enrolled in the New York State Health Insurance Program (either the Empire Plan or health maintenance organization) are entitled to reimbursement once annually for NYSHIP prescription drug co-payments and covered prescriptions less than the co-payment for themselves and their eligible dependents. Once co-payments reach $300, the next $150 in prescription drug co-payments is reimbursable. If you did not accumulate $450 by the end of last year, submit your claim for what you did pay over $300. Prescription Drug Co-Payment Reimbursement Form for New York State Liquidation Bureau Employees Members who are enrolled in the New York State Health Insurance Program (either the Empire Plan or Health Maintenance Organization) are entitled to reimbursement once annually for NYSHIP prescription drug co-payments and covered prescriptions less than the co-payment for themselves and their eligible dependents. Once co-payments reach $300, the next $100 in prescription drug co-payments is reimbursable. If you did not accumulate $400 by the end of last year, submit your claim for what you did pay over $300. Unified Court System Combined Co-Payment Benefit Claim Form Reimburses prescription drug co-payments and co-payments for physician office visits. The claim can be made up of both types of co-payments for a combined maximum reimbursement of $325. Unified Court System Retiree Co-Payment Claim Form Reimburses prescription drug co-payments only up to a maximum of $100. Physician co-payments for office visits are reimbursed up to a maximum of $125. Local Government Co-Payment Claim Form For local government employees that have a negotiated prescription drug co-payment and/or physician co-payment reimbursement benefit. Submit the claim along with your itemized pharmacy and/or Explanation of Benefits (EOB) from your health insurance carrier. Please contact either our Member Services Department or refer to your collective bargaining agreement to verify the level and type of reimbursement available for you. Get your claim form by visiting EBF’s website at www.cseaebf.com and following the Download Forms link. No username or password is required to enter the site. Empire Plan claims deadlines for 2013 Empire Plan enrollees have until April 30, 2014 (120 days after the end of the calendar year) in which to submit medical expenses which were incurred during the 2013 plan year to: United HealthCare Service Corp. P.O. Box 1600 Kingston, N.Y. 12402-1600 For the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for nonnetwork physical therapy or chiropractic services. Empire Blue Cross and Blue Shield NYS Service Center (Code YLS) P.O. Box 1407 Church Street Station New York, N.Y. 10008-1407 For Empire Plan and non-network Inpatient or Outpatient hospital services. OptumHealth Behavioral Solutions P.O. Box 5190 Kingston, N.Y. 12402-5190 For non-network mental health and substance abuse services. Medco Health Solutions P.O. Box 14711 Lexington, KY 40512 For prescriptions filled at nonparticipating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card. Enrollees can call the Empire Plan at 1-877-7NYSHIP (1-877-769- 7447) with questions or to obtain claim forms. As a reminder, when using the Empire Plan’s toll-free telephone number, please pay extra attention to the choices offered by the automated system. Network providers/pharmacies will submit claims directly to the appropriate insurance carrier on your behalf when provided with all necessary information. If you have a non-network claim submission, make sure you complete the requested subscriber information on the claim form, include the original billing or receipt (if requested), and don’t forget to sign the claim form. March 2014 The Work Force 17
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