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.

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.

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.

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.

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.

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

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, 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.

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.

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.