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Reimbursement procedures
To make a claim for Plan benefits, a Claimant must present proof of payment
of a
Qualified Expense, on a form approved by the Trustees, to the Trust Office
at:
Miami
Association of Fire Fighters Health Benefit Trust
c/o Miami Association of Fire Fighters, Local 587
2980 NW South River Drive
Miami, FL 33125-1146
- Prior
to issuing payment, the Trust Office shall review such proof and determine
whether to grant or deny coverage under the Plan.
- All
claims and appeals must be submitted by an Eligible Retiree. Upon the
Eligible
Retiree’s death, the Eligible Retiree’s Surviving Spouse must submit all claims and
appeals. If there is no Surviving Spouse, then the Eligible Retiree’s Dependents may
submit claims and appeals.
- If the
Trust Office grants coverage, payment will be made to the Claimant.
If the
Trust Office denies coverage, the Claimant may appeal the denial of coverage or any
other adverse benefit determination of the Trustees under Section 4.3 hereof.
- Proof
shall include, but not be limited to, canceled checks drawn to the name
of the
provider, or receipt for payment from the provider, subject to verification as
determined by the Trustees in their sole discretion.
- Claims
for Plan benefits must be submitted no later than 180 days from the
date on
which the Claimant made the payment of Qualified Expenses to the insurance
provider. This 180-day limit may be waived by the Trustees upon good cause shown
by the Claimant.
- Any reimbursement in excess of $10,000.00 will be paid out in installments.
Please Note: We will no longer be depositing reimbursement checks into any member’s credit union accounts. The board understands that this will be an inconvenience to some but was a necessary decision due to our increasing membership. All reimbursement checks will be mailed to your current home or p.o. box address so please be sure that we have your most recent address on file by contacting our office @ 305-633-3442 or by email at healthtrustadmin@iaff587.org.
