Specialist Co-pay Reimbursement

Chairman Levler and the Board of Trustees are excited to announce that as of June 1st 2022 members may now request a Specialist Co-Payment Reimbursement Form from the Benefit Fund (631 319-4099 or on our website).

All active members will now be eligible to receive a $20 copay reimbursement for every Specialist copay of $50 or more that the member and their covered beneficiaries paid in 2021. There is no maximum dollar limit, but reimbursements are limited to Specialist visits. General Practitioner, Urgent Care, Emergency Room and laboratory visits are not eligible. You must be a member of EMHP to receive this benefit. All rules and regulations governing the “health plan” apply to your Fund coverage.

Members can request a claims printout from Empire Blue Cross Blue Shield by calling 1-800-939-7515 or print one out themselves (instructions are below).

Claims for specialist co-payments can only be filed ONCE annually. Submit ONLY after you have accumulated all your co-payment costs for the entire year. Additional reimbursement requested by a member who previously filed a claim, which was previously processed and paid, will be rejected!

The claim form along with the necessary documentation can be submitted starting June 1st for specialist copays accumulated for the previous calendar year and must be submitted by May 31st of the following year (For example, you may submit your claims after June 1, 2022 for your 2021 specialist co-pays and the claim must be received by the Fund office no later than May 31, 2023).

WHO IS ELIGIBLE:
Active member, spouse, duly enrolled domestic partner, unmarried dependent children to age 26 or dependent children incapable of self-sustaining employment by reason of mental or physical disability acquired before the termination of eligibility (prior to the age of twenty-six {26}and reside with and wholly depend upon the covered member for support.) The member must be enrolled in EMHP to receive this benefit.

PRINTOUT FILINGS:
Specialist visits are for an active member, spouse or eligible domestic partner and covered children (see definitions below). Identify each family member and submit all printouts for each person.

INDIVIDUAL RECEIPTS:
Individual receipts will NOT be accepted as proof of payment!

EXCLUSIONS:
• Urgent Care
• Emergency Room Visits
• Laboratory Visits

HEALTH CARE PLAN PRINTOUT:
Complete all required areas of information, sign, and date the form and attach a printout from your health plan coverage.

INSTRUCTIONS: Go to https://www.empireblue.com/login/ & login. If you have not created an account, please do so. Once logged in hover over “Claims & Payments” on the Menu bar & click on “Claims & Explanation of Benefits”. Scroll down until you see “Claims History”. Click on “Filter Claims” & choose 1/1 to 12/31 of the year you are filing for. *
Then to Print: Right click & click print or Press Ctrl + P

*NOTE: Please do NOT click Export claims. A csv file will NOT be accepted as proof of payment!