Know your benefits
Welfare Fund offers new benefit and 2007 ‘Red Apple’
Mar 15, 2007 12:10 PM
The UFT Welfare Fund is offering a new benefit on enteral formulas and a new “Red Apple” booklet, one for in-service members and one for retirees, that describes the new benefit as well as all others.
The completely revised booklets, which update the previous ones published in 2004, will be received by members in their homes during April and will also be posted online at www.uftwf.org.
The new enteral formula benefit (for in-service members and their families) covers nutritional prescriptions — not supplements — that are taken by mouth to cure any number of illnesses, such as Crohn’s disease, gastroesophageal reflux, severe food allergies and others.
In order to receive this benefit, members must use the Welfare Fund’s prior approval process and it must be renewed every year. The formula must be for home use and must be prescribed by a physician or other legally authorized health care provider.
Although the Fund was not mandated under New York legislation to provide this coverage, the Fund’s trustees decided to offer the benefit to assist those members who would otherwise not have coverage for such prescriptions.
To access these types of prescriptions members should follow these steps:
- Contact the Fund with the request for the specific enteral formula and the procedure to follow for prior authorization.
- The written order presented to a pharmacy must state that the enteral formula is medically necessary, meaning that it has proven effective as a disease-specific treatment regimen for a disease that, if left untreated, will cause chronic disability, mental retardation or death.
- Coverage for any 12 continuous months is limited to $2,500. Quantities are limited to 30-day supplies and are considered Non-Preferred Brand (Tier 3) for co-payment purposes.
