MTABFP.O. Box # 656
Baldwin Place, NY 10505 Phone: 845.543.7415 |
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UNDERSTANDING THE VARIABLE BENEFIT
WHO IS COVERED?
This benefit is available to the active enrolled members & retirees who have chosen the COBRA Plan. It is used to apply for reimbursement for covered expenses incurred by the covered member and his/her eligible dependents.
WHAT SERVICES DOES THE PLAN COVER?
The Variable Benefit Plan was implemented to further minimize out-of-pocket expenses to you and your family. The Variable Benefit Plan provides a monetary reimbursement per plan year (July 1 through June 30) per family for eligible expenses incurred in any combination of the above benefits. Claims must be filed no later than July 31st of the covered year (July 1 through June 30). The plan covers out-of-pocket expenses that exceed the maximums of certain Fund benefits, which are the following:
1. Active members - utilize it to defray the cost of enrolling a spouse &/or dependent(s) in MTABF Dental.
2. All Prescription drugs and their co-payments for those drugs which are otherwise covered under your basic health plan;
3. Optical expenses and services in excess of the $100 maximum under the Fund's Optical Benefit Plan reimbursement option;
4. Charges in excess of the dental plan fee schedule (remember, participating dentists accept the Fund's fee schedule as payment in full) for members or charges incurred for services rendered to a member's spouse and/or eligible dependent children;
5. Charges in excess of the dental fee schedule ($1,800 annual maximum for regular dental services and $2,200 lifetime maximum for orthodontic services) for the member or charges incurred for services rendered to a member's spouse and/or eligible dependent children;
6. Hearing aid expenses in excess of $300 every three years incurred by the member or eligible dependent or for charges incurred for services rendered to a member's spouse and/or eligible dependent children; or
7. Doctor visit co-payments for services otherwise covered by your basic health plan.
8. Over the Counter Medications & Products- Download a copy of the list for specifics.
9. Wellness Benefit:
WHAT SERVICES ARE NOT COVERED BY THE PLAN?
The Variable Benefit Plan applies only to those covered expenses eligible for reimbursement under the rules and regulations of each individual plan that this plan supplements, as indicated above. The Variable Benefit Plan does not supplement the Fund's Life Insurance and AD&D Benefit plan or the Fund's Legal Services Plan
HOW ARE THE BENEFITS OBTAINED?
Complete the Variable Benefit Claim Form and submit it, along with receipts of your expenses and your Explanation of Benefits form from your basic health plan. Claim Forms are returned because people do not read directions. The claim form must be filled out in its entirety & all receipts must be attached. Claims must be filed no later than July 31st of the covered year (July 1 through June 30). Claims submitted later than July 31st, will not be covered. Claims that are not properly completed or filed after July 31st will be returned to the member.
Completed forms should be mailed to:
Mahopac Teachers Association Benefit Fund
c/o Administrative Services Only, Inc.
P.O. Box 9005
Lynbrook, NY 11563
WHO IS COVERED?
This benefit is available to the active enrolled members & retirees who have chosen the COBRA Plan. It is used to apply for reimbursement for covered expenses incurred by the covered member and his/her eligible dependents.
WHAT SERVICES DOES THE PLAN COVER?
The Variable Benefit Plan was implemented to further minimize out-of-pocket expenses to you and your family. The Variable Benefit Plan provides a monetary reimbursement per plan year (July 1 through June 30) per family for eligible expenses incurred in any combination of the above benefits. Claims must be filed no later than July 31st of the covered year (July 1 through June 30). The plan covers out-of-pocket expenses that exceed the maximums of certain Fund benefits, which are the following:
1. Active members - utilize it to defray the cost of enrolling a spouse &/or dependent(s) in MTABF Dental.
2. All Prescription drugs and their co-payments for those drugs which are otherwise covered under your basic health plan;
3. Optical expenses and services in excess of the $100 maximum under the Fund's Optical Benefit Plan reimbursement option;
4. Charges in excess of the dental plan fee schedule (remember, participating dentists accept the Fund's fee schedule as payment in full) for members or charges incurred for services rendered to a member's spouse and/or eligible dependent children;
5. Charges in excess of the dental fee schedule ($1,800 annual maximum for regular dental services and $2,200 lifetime maximum for orthodontic services) for the member or charges incurred for services rendered to a member's spouse and/or eligible dependent children;
6. Hearing aid expenses in excess of $300 every three years incurred by the member or eligible dependent or for charges incurred for services rendered to a member's spouse and/or eligible dependent children; or
7. Doctor visit co-payments for services otherwise covered by your basic health plan.
8. Over the Counter Medications & Products- Download a copy of the list for specifics.
9. Wellness Benefit:
- Gym Memberships - membership fees only; submit for reimbursement for paid membership fees after the paid cycle is complete (ie: if you pay monthly, you submit for reimbursement after the month is over) In order to receive reimbursement, complete documentation, including proof of payment, must be provided.
- Diet Memberships - membership fees only; submit for reimbursement for paid membership fees after the paid cycle is complete (ie: if you pay monthly, you submit for reimbursement after the month is over). This benefit covers membership only & does not cover the cost of food, aid products, etc. In order to receive reimbursement, complete documentation, including proof of payment, must be provided.
- Smoking Cessation - Smoking Cessation products are already covered under OTC. This benefit will additionally cover any therapeutic smoking cessation sessions/classes. In order to receive reimbursement, complete documentation, including proof of payment, must be provided.
WHAT SERVICES ARE NOT COVERED BY THE PLAN?
The Variable Benefit Plan applies only to those covered expenses eligible for reimbursement under the rules and regulations of each individual plan that this plan supplements, as indicated above. The Variable Benefit Plan does not supplement the Fund's Life Insurance and AD&D Benefit plan or the Fund's Legal Services Plan
HOW ARE THE BENEFITS OBTAINED?
Complete the Variable Benefit Claim Form and submit it, along with receipts of your expenses and your Explanation of Benefits form from your basic health plan. Claim Forms are returned because people do not read directions. The claim form must be filled out in its entirety & all receipts must be attached. Claims must be filed no later than July 31st of the covered year (July 1 through June 30). Claims submitted later than July 31st, will not be covered. Claims that are not properly completed or filed after July 31st will be returned to the member.
Completed forms should be mailed to:
Mahopac Teachers Association Benefit Fund
c/o Administrative Services Only, Inc.
P.O. Box 9005
Lynbrook, NY 11563
