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.

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

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.

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.

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.

You may submit a Prescription Drug Reimbursement Form (also available by calling our Forms Hotline at 212-539-0539) with a copy of the paid pharmacy receipt, indicating the patient name, drug name, dosage and quantity.

When the Fund pays out in excess of $1,200 for 12 months from December through November for an individual member or family (or $2,400 for SCOB – a member with a spouse/domestic partner who is also an in-service member), the member is placed in the Cost Care Program on January 1st of the calendar year. Cost Care participants who want brand-name drugs must pay the cost difference between the brand name and the generic if available, plus the applicable copay.

Yes, the Fund will pay for contact lenses as per the fee schedule, but not in addition to glasses.

Members and their spouse/ domestic partner who are also members are entitled to special coordination of benefits (SCOB). This entitles each eligible family member, upon request at the same time for two (2) covered services, one (1) service under each member's benefit record, whether using a participating provider or the direct reimbursement method. In either event, reimbursement to the provider or the member may not exceed the actual charge for the optical service under SCOB.

We suggest that you use your optical benefits only for full services, which include glasses or contacts along with an eye exam. If you use your benefits and only get the exam we will pay $20 toward an exam fee, but you will be deemed to have used the entire benefit amount and will not be eligible for another optical benefit for one year. Instead, if you pay for your exam directly and save the benefit, you can use it when you are ready to purchase your frames or lenses.