2017 Reimbursement

What costs are covered by the Supplemental Trust
For participants who have health insurance through Medicare
What costs are not covered by the Supplemental Trust
Reimbursement forms
Direct Deposit forms

What costs are covered by the Supplemental Trust:

For participants who have health insurance through a Trust approved plan, offered through the applicable Exchange:

The Supplemental Trust covers any amount of your premium above and beyond your federal tax credit.

• If you are signed up as an individual only, the Trust will provide your premium assistance through your Benefit Convenience Card directly. You will need to set up your card with your insurance carrier directly. Please refer to the Benefit Convenience Card Set-Up instructions for the medical plan your choice, which can be found on the Resources page for assistance. For more information about your Benefit Convenience Card, please see the Benefit Convenience Card - Frequently Asked Questions.
• If you are signed up with family members, you need to pay your premium bill directly to the insurance carrier and the Trust will reimburse you for the portion of the premium applicable solely to your individual coverage. Pay the bill and then use this website to submit a copy of the bill with the reimbursement form.

In addition to your premium, the Trust reimburses for:

Your Exchange plan deductibles, copays and coinsurance: You will be eligible for coverage of up to $3,000 in 2016 and up to $4,000 in 2017 per calendar year from the Trust for your covered deductible, copayment and coinsurance expenses relating to any claims you incur that are covered under the Trust-approved Exchange plan in which you are enrolled.

You may pay for covered deductibles, copayments and coinsurance expenses at the point of service using the Benefit Convenience Card issued to you by the Trust.

If you have not received your Benefit Convenience Card, please follow the Trust’s reimbursement process by submitting a completed Ameriflex Reimbursement Form along with a copy of your explanation of benefits ("EOB").

Your maximum yearly reimbursement is $3,000 in 2016 and up to $4,000 in 2017 for all deductible, copayment and coinsurance costs covered by your Trust-approved plan.

For participants who have health insurance through Medicare:

The Supplemental Trust provides reimbursement for:

• The Medicare Part B Premium of up to $121.80
• Up to $41 in 2016 and up to $44 in 2017 per month towards either a Medicare Advantage Plan, a Medicare Supplement Plan or Medicare Part D
• Your Medicare Part B and Supplemental/Advantage/Part D plan deductibles, copays and coinsurance: You will be eligible for coverage of up to $3,000 in 2016 and up to $4,000 in 2017 per calendar year from the Trust for your covered deductible, copayment and coinsurance expenses relating to any claims you incur that are covered under your Medicare Part B and Medicare Advantage, Medicare Supplement or Medicare Part D plan in which you are enrolled. You may pay for covered deductibles, copayments and coinsurance expenses at the point of service using the Benefit Convenience Card issued to you by the Trust. If you have not received your Benefit Convenience Card, please follow the Trust’s reimbursement process by submitting a completed Ameriflex Reimbursement Form along with a copy of your explanation of benefits ("EOB").

What costs are not covered by the Supplemental Trust:

The Supplemental Trust does not cover the following costs; you are responsible for paying these on your own.

• Family members: There is no assistance provided for non-Trust eligible participant's medical premium or plan expenses, to include family members.