Get the free RETIREE EXCESS MEDICAL CLAIM FORM Feb 2014doc

RETIREE EXCESS MEDICAL BENEFIT CLAIM FORM MAIL CLAIM TO: East Williston Teachers Association Benefit Trust Fund 253 West 35th Street 12th Floor, New York, New York 10001 Mobile Monowitz (212) 5055050

How to fill out retiree excess medical claim

How to Fill Out Retiree Excess Medical Claim:

1. Obtain the retiree excess medical claim form from your healthcare provider or insurance company. It may be available online or you may need to request it specifically.
2. Fill in your personal information accurately and completely. This typically includes your full name, address, contact number, and policy or member ID.
3. Provide details about the medical service or treatment for which you are making the claim. Include the date of service, the name and address of the healthcare provider, and any relevant medical codes or descriptions.
4. Indicate the amount you are requesting for reimbursement. Include any deductibles, copayments, or coinsurance that you are responsible for paying.
5. Attach all necessary supporting documents. This may include itemized bills, receipts, or explanation of benefits (EOB) forms from your primary insurance.
6. Sign and date the claim form to validate the information provided.
7. Make copies of the filled-out form and all supporting documents for your records before submitting them.
8. Submit the completed retiree excess medical claim form and supporting documentation to the specified address indicated on the form or through the online portal, if available.
9. Follow up with your healthcare provider or insurance company to ensure that your claim is being processed and to address any additional information they may require.

Who Needs Retiree Excess Medical Claim?

1. Retirees who are no longer employed but still have access to medical benefits through their previous employer's retirement healthcare plan.
2. Individuals who have reached the age of retirement and are covered under a retiree healthcare plan that provides excess coverage beyond what Medicare or their primary insurance may cover.
3. Those who have incurred medical expenses that exceed the limits or coverage provided by their primary insurance and need to seek reimbursement for the excess amount from their retiree healthcare plan.

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