NEW YORK CITY ELECTRICAL DIVISION HEALTH & WELFARE FUND

PRESCRIPTION DRUG BENEFITS
STARTING JANUARY 1, 2015
PRESCRIPTION REIMBURSEMENT CLAIMS

To submit a claim you must fill out a prescription claim form supplied by the New York City Electrical
Division Welfare Fund and return it to us along with your receipt from the pharmacist.

IMPORTANT
NO REIMBURSEMENT WILL OCCUR IF THE RECEIPT THAT ARE SUBMITTED ARE OLDER THAN  120 DAYS OLD


PRESCRIPTION DRUG FORM LINK



The Welfare Fund will reimburse you up to $ I,OOO.
We do not pay individual claims under  $IO.OO

THE WELFARE FUND

WILL NOT reimburse you up to $1000 towards the purchase of High Option Drug Rider.

WILL reimburse you up to $1000 towards prescription drug purchases.

PRESCRIPTION DRUG BENEFITS

Benefits are payable according to the stipulations below for covered prescription drug purchases while the member and dependent (s) – if any - remain eligible to receive them.

• Who Is Covered

Prescription drug benefits are available for most medications prescribed by a physician for the member and any eligible dependent (s).

• What Charges Are Covered

Most medications prescribed by a physician are covered under this section. However, the Plan encourages the member to consider the use of generic drugs rather than name-brand medications since the former afford the best return on the dollar. (When the doctor prescribes a medication, ask whether there is a generic drug alternative, and, if there is, have the prescription written accordingly.)

The following conditions apply;

A. There is a maximum, annual prescription drug benefit of$1,000 per family.

B. The prescription drug benefit is subject to the provisions described in the "Non-duplication of

 Benefits "section found in the "General Information" portion of this booklet;

C. The following items are excluded under the prescription drug program:

(1) Medications obtained without a prescription;

(2) Non -legend medications;

(3) Medications for which a hospital makes a change;

(4) Medications provided through or received from the pharmacy of the member's employer that would normally have been available without cost to the member;

(5) Medications which are covered under any governmental program or law for which no charge is made or there is no legal obligation to pay

-OR-

Which are dispensed in a hospital (contracted for or operated by the United States Government) for the treatment of members or ex-members of the Armed Forces

-OR-

Which are dispensed by a rest home, sanitarium, sanatorium, drug or alcohol rehabilitation center or other similar institution

(6) Any contraceptive materials or any therapeutic device (e.g. hypodermic needles, syringes, support garments or other non-medical items or substances) regardless of the intended use.

PRESCRIPTION REIMBURSEMENT CLAIMS

To submit a claim you must fill out a prescription claim form supplied by the New York City Electrical Division Welfare Fund and return it to us along with your receipt from the pharmacist. The Welfare Fund will reimburse you up to $1,000.

We do not pay individual claims under SI0.00

DRUG RIDER REIMBURSEMENT

Note: The total of the prescription and drug rider reimbursement together cannot exceed $1,000 per family per calendar year.

Tel (718) 820-1690

Fax: (718) 820-1691

The New York City Electrical Division Welfare Fund's 

 click of picture below for Website