Who is eligible?
Prescription copay 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".) Members are eligible once they enroll for trust fund benefits, and they must work at least 17.5 hours per week. Retirees must also be enrolled in the Enhanced or Enhanced Plus Plans to be eligible for this reimbursement. Download a reimbursement form below.
What is the benefit?
Once annually, up to a maximum of $300 plus 1% for every prescription after the initial $300 is met, the Fund reimburses the member for 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 a pharmacy printout or a copy of the 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 $300 plus 1% for every prescription after the initial $300 is met, or at any time at the end of the calendar year for your total, which may be less than $300.
How to file a claim?
Instructions for filing Prescription Reimbursement Form
Prescription Reimbursement Form to submit
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.