Medical Coverage - Dependent Accident Reimbursement

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» How to Qualify
» How to Apply


$500 Maximum Reimbursement per Plan Year per Child

Dependent Accident Reimbursement Form: Click Here

How to Qualify

» If a Covered Dependent Child receives Covered Services in an emergency room, urgent care facility or minor emergency center for an accidental injury, the Plan will pay for the first $500 of your out-of-pocket costs for that claim, or, if your out-of-pocket costs for that claim are less than $500, the lesser amount.
» You must apply for the reimbursement no later than 3-months after the end of the Plan Year.
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How to Apply

» Notify the Health Plan of the claim, you must complete an Accidental Injury Claim Form, attach a copy of the Explanation of Benefits (EOB) for the claim, then mail it all to the Health Plan Administrators Office.
» Once approved, the Health Plan will then have the Claims Administrator adjust the claim to accommodate the approved benefit.
» The Claims Administrator will re-process the claim, and pay any additional amounts to the Provider.
» The Provider should then reimburse the Member any amounts paid to the Provider (Out-of-Pocket) which are no longer required according to the reprocessed claim.
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