Medical Benefits
| PROVIDER & SERVICE | ADDRESS & PHONE |
| Empire Plan |
Empire BlueCross
BlueShield 11 W. 42nd St New York, N.Y. 10036 Telephone: (212) 476-1000 Fax: (212) 476-1281 |
J.J. Stanis & Co., Inc. / Davis Vision Care Program
|
J.J.
Stanis and Company, Inc.
100
Jericho Turnpike Suite 101
Jericho, New York 11753
Davis Vision 1-800-999-5431 |
Members are reminded to make copies of all materials submitted. It is recommended to mail this information return receipt.
WHO CAN FILE A CLAIM FORM:
Only employees participating in the EASO Benefit Fund can file a reimbursement claim form.
Employees can file a claim form four (4) times during the plan year (March, June, September, December) All claims for a benefit year(January-December) must be filed by March 31st of the next year.
Members are encouraged to wait until they have a few EOB’s before filing.
WHAT EXPENSES CAN BE CLAIMED:
Only expenses incurred during the plan year can be claimed for reimbursement. The year of claim is the year the expense was incurred by the participant. It is imperative to send separate claim forms fro each year.
Consult your plan provider for description of allowable expenses. An allowable expense is one that is recognized by the Internal Revenue Service as a medical/dental expense.
The procedures outlined below should be followed in filing medical, dental and vision care claims. REMEMBER there are deadlines for each individual policy.
Vision Care:
The year for vision care claims is from
January 1 – December 31. You are
entitled to use this benefit once a year.
·
If you use a participating
provider, simply call and make an
appointment, telling them that you are a member of the J. J. Stanis / Davis
Vision Care Program. If you are unsure of participating providers, call
1(800) 999-5431. Any out-of-pocket expenses may be submitted to the EASO
Benefit Fund.
·
If you use a non-participating
provider, present the provider with a
Vision Care Statement of Claim (located in the main office of each building).
Any out-of-pocket expenses may be submitted to the EASO Benefit Fund for
reimbursement.
Dental Care:
The year for dental claims is January 1 – December 31.
·
Whether
or not you use a participating provider,
present the dentist with a dental form (located in the main office of each
building). Again, any out-of-pocket expenses may be submitted to the EASO
Benefit Fund for reimbursement.
Medical Care: The year for medical claims is from January 1 – December 31. You have until March of the following year to submit claims from the previous year.
·
If you use a participating
provider for medical care or drugs, any
out-of-pocket expenses may be submitted to the EASO Benefit Fund (including
co-payments).
·
If you use a non-participating
provider for medical care, submit
claims to METRAHEALTH. (Forms located in the main office of each building.)
Expenses not covered should be submitted to FIRST REHABILITATION
INSURANCE COMPANY. (Forms located in the main office of each building.)
Expenses not covered by First Rehabilitation may be submitted to the EASO
Benefit Fund.
EASO Benefit Fund:
The year for claims is from January 1 – December 31. You have
until March of the following year to submit claims from the previous year.
· The EASO Benefit Fund will reimburse you for any out-of-pocket expenses to a maximum of $550 a year. (Forms located in the main office of each building, or click here.) The forms are mailed to J. J. Stanis & Co., Inc. The address is on the form. ALL CLAIMS SHOULD BE MAILED RETURN RECEIPT REQUESTED.
· When submitting claims for payment to a second or third provider, submit all statements from previous providers. Keep copies of all submitted claims
If you have any questions, please don't hesitate to contact Dan Sullivan (x7250)
For the EASO Benefit Fund,
Dan Sullivan, Chairman