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Frequently Asked Questions

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A list of the most commonly asked questions.

Why isn’t my diabetes drug covered?

It is covered, but not by the Welfare Fund. By state law, health plans cover diabetes drugs and ancillary devices. Please call your health plan for details.

How does the mail order program work for prescription medications?

Maintenance medications (those taken regularly over an extended period) cannot be filled in monthly quantities after they have been filled three (3) times (original prescription plus two (2) refills), regardless of the number of refills indicated on the prescription. After the second refill, to continue using the drug, you must obtain a new prescription from your physician for 90 days supply or 100 pills/capsules, whichever is greater, and then use the ESI Home Delivery Service.

Mail the original prescriptions in the postage paid envelope along with a completed order form to the Express-Scripts Home Delivery Service.

I am a GHI subscriber and I need some medical equipment (known as durable medical equipment). Can I file for reimbursement with the UFT Welfare Fund?

First, submit your claim to GHI for reimbursement. If GHI reimburses you minus the $100 deductible, in-service members can then submit a completed Welfare Fund GHI DME deductible reimbursement form, along with the GHI explanation of benefits to the Fund. If eligible, the Fund will reimburse you the $100 deductible.

I just purchased a prescription appliance and HIP rejected the claim. Can I submit this claim to the UFT Welfare Fund?

Yes, the Welfare Fund will reimburse for certain covered appliances for in-service members that meet our medical advisor’s and HIP guidelines. The benefit pays 80 percent of reasonable and customary charges after a $25 annual deductible per person.

Is there a cap on the Welfare Fund reimbursement for prescription appliances for HIP subscribers?

Yes, this benefit is capped at $1,500 a year and $3,000 for a lifetime.

I had surgery and now I am being billed for the anesthesia because HIP rejected the claim. Can I file with the Fund for payment?

Yes, the Welfare Fund pays 80 percent of reasonable and customary charges when the benefit is not covered by HIP PRIME for in-service members. To file for payment, you need to complete a Welfare Fund anesthesia claim form and attach an itemized paid bill from the provider along with a rejection letter from HIP.

My spouse and I participate in a Medicare Part D drug plan. If either or both of us hit the catastrophic portion of this coverage, can we submit a claim for reimbursement to the UFT Welfare Fund?

Yes, you and your spouse are both eligible for reimbursement of your catastrophic co-payments under your Medicare Part D coverage. Each of you individually has to reach the annual catastrophic limit; your totals cannot be combined. Claims must be submitted by Feb. 1 for the prior year’s reimbursement. The Fund prepares a new form in December of each year for your use in filing for this reimbursement.

Can I change my pension tier?

You may qualify for a different tier if you switched tiers during a tier change period, or if you transferred your membership to TRS from another eligible retirement system. In addition, you can apply for reinstatement to your previous status if you are presently a TRS in-service member and lost your tier membership in TRS or another New York City or New York State public retirement system. You may obtain a Membership/Tier Reinstatement Request Form (SD42) in the “Tools” section of the TRS website at www.trsnyc.org or by calling TRS at 888-8NYCTRS. To be reinstated, you must pay back the contributions that were refunded when your membership ended, plus 5 percent interest from the date of the refund to the date of repayment. BERS members should call 929-305-3800.

Why is the pension number box on my paystub blank?

If you are an appointed teacher, the box may be blank because you have not filed an enrollment application or (if you have) because your application is still being processed. If you are not an appointed teacher and have not filed an enrollment application with the Teachers’ Retirement System, the box is blank because you are not yet a TRS member; you must file an enrollment application to join TRS.

Is the amount of my pension guaranteed?

Yes, the type of pension plan that covers UFT members is called a defined benefit plan because the amount of your annual pension payments is defined by law and guaranteed by the state government for as long as you live.