How To Obtain Your Benefits
Before you can file a claim for any benefit in the DC 37 Health
and Security Plan we have to find out who you are and whether you are covered. THAT
MEANS THAT YOU MUST FILE AN ENROLLMENT CARD WITH THE DC 37 HEALTH AND SECURITY
PLAN. This card gives all the necessary information about you and your
family.
If a death, marriage, birth, adoption divorce or separation has
changed the size of your family, the Plan must be told of the changes. You must
inform the Plan by filling out a Change of Status form and providing the proper
papers (birth, marriage, death certificates, etc.) Of course, you must also
advise the Plan of any change of address. You will not receive your
prescription drug card or payment for a benefit claim if the Plan does not know
current address. Filing an Enrollment Card is the first step in receiving
benefits.
After that has been done, you must comply with following
procedures for obtaining the particular benefits. In order to receive or obtain
reimbursement for benefit expenses incurred, it is necessary to file the
appropriate application or claim form with the Plan Office.
HERE'S HOW TO OBTAIN YOUR BENEFITS:
All claim forms and participating provider listings are available from the Plan
office Call the Inquiry claim forms line at (212) 815-1234. In order to
expedite claims processing send completed claims to the Plan office at 125
Barclay Street.
CATASTROPHIC MEDICAL BENEFIT:
Claims must be filed within 30 days after accumulating at least $1,000 in
covered out-of-pocket expenses. Copies of all related claims submitted to GHI
and all vouchers received from GHI must accompany all claim forms to the Plan.
SECOND SURGICAL CONSULTATION:
Call the Plan at (212) 815-1350 regarding this benefit.
DENTAL BENEFIT: After any dental
work or course of treatment has been completed, you and your dentist must fill
out a dental claim form. It must be files within 30-days after the work is
completed. Orthodontic claims must be filed quarterly. Please see dental
section for pre-file requirements.
PRESCRIPTION DRUG BENEFIT:
If you use a Participating Pharmacist, use your Prescription Drug Card. Have
your doctor write the prescription on his/her prescription drug form and bring
both the form and card to the Participating Pharmacist. If you do not use the
Prescription Drug Card, you and your Pharmacist must use the direct
reimbursement claim form. The completed direct reimbursement claim form must be
filed within 30-days after you have paid for the drugs.
OPTICAL BENEFIT: If you use a
Participating Optometrist or Optician, all you need is a Voucher from the Plan
office. If you do not use a Voucher, the Optometrist or Optician and you must
fill out a direct reimbursement form that must be filed within 30-days after
you have paid for the glasses.
DISABILITY INCOME BENEFIT:
You must file the completed Disability Claim form within 15-days after the
beginning of your disability, regardless of accumulated sick, vacation, or
annual leave time.
DEATH BENEFIT: The Plan office
should be notified of the death of a covered employee by phone or letter. The
appropriate claim form will will be sent to the named beneficiary. If a member
is not survived by any beneficiaries or failed to name any beneficiaries, then
the benefit will be paid according to the rules and regulations of the DC 37
health and Security Plan Document. These forms must be returned to the Plan
with a death certificate, within 30-days.
ACCIDENTAL DEATH, DISMEMBERMENT AND LOSS OF SIGHT BENEFIT:
The form must be completed by a doctor and filed within 30-days of the death or
loss of sight or limb.
Members are reminded that claim forms must be filed in a timely
manner. If the claim is filed late, a written excuse for the late filing period
must be submitted before the claim is considered for payment. The Plan cannot
and will not pay any claims, regardless of excuse, if the claim is filed more
than 90 days after the first day a claim could have been filed. Remember: you
are responsible for filing the claim and not your health care provider.
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