What are supplemental benefits?
Supplemental Benefits, as described below, are benefits provided by the UFT Welfare Fund that add to specific City basic health plans.
The Welfare Fund provides supplemental benefits for the following plans:
- HIP PRIME
- HIP PRIME POS
The supplemental benefits differ, according to the plan.
Who Is Covered?
All eligible members and dependents who are enrolled in one of the City basic plans listed above are covered, including members enrolled as dependents under their spouse’s or domestic partner’s City basic plan.
Note: Welfare Fund Supplemental Benefits are only available to dependents enrolled under the same City Contract as the member. However, the other Welfare Fund Benefits are available.
What are the benefits and how are they obtained?
HIP PRIME Enrollees:
- Private Duty Nursing: After a 72-hour deductible, eighty percent (80%) of reasonable, usual and customary charges for in-hospital services performed by a registered nurse, from the fourth day through the 60th day of nursing care, are paid by the Welfare Fund.
- Anesthesia: The Welfare Fund pays eighty percent (80%) of reasonable, usual and customary charges, when not covered by HIP PRIME.
- Prescription Appliances: The Welfare Fund pays eighty percent (80%) of reasonable, usual and customary charges for covered appliances,* after a $25 annual deductible per person, subject to a $1,500 maximum per year/$3,000 lifetime.
*Note: The Fund follows guidelines established by HIP and the Fund's Medical Advisor. Those appliances that meet these standards are covered.
To obtain benefits for private duty nursing, anesthesia or prescription appliances, a completed claim form, along with an original itemized paid receipt, must be submitted to the UFT Welfare Fund by the member. The benefit is not assignable and only paid directly to the member. In addition, when submitting an anesthesia claim form, you must attach a copy of the HIP PRIME rejection letter.
Any member who is enrolled in the City basic health plan as a dependent under his or her spouse's/domestic partner’s City plan must attach a photocopy of the HIP PRIME ID Card to the claim form.
HIP PRIME POS Enrollees:
The benefits described immediately above for HIP PRIME enrollees are also available to HIP PRIME POS enrollees. However, HIP PRIME POS is primary and all claims must be sent to them first. After HIP PRIME POS processes your claim for the above services, you should submit to the UFT Welfare Fund a completed claim form, a copy of the paid bill and the EOB (Explanation of Benefits) from HIP PRIME POS for reimbursement of any remaining out-of-pocket expenses.
Payment for any remaining out-of-pocket expenses is subject to the maximum benefit available as described above. In no case will the Welfare Fund pay more than what would have been paid to a HIP PRIME POS subscriber by HIP. You are not entitled to receive more than 100% of your expenses.
Durable Medical Equipment: The Fund will reimburse GHI-CBP enrollees up to $100.00 per calendar year for the deductible incurred in the purchase or rental of Durable Medical Equipment otherwise covered by GHICBP.
A completed “GHI-CBP DME Reimbursement Form” claim form, along with an original Explanation of Benefits (EOB) from GHI, must be submitted to the UFT Welfare Fund by the member at the end of the calendar year or when $100.00 of out-of-pocket expenses has been incurred, whichever is sooner. Durable Medical Equipment claim forms are also available upon written request to the Fund office or by calling the Forms Hotline 212-539-0500.