Dependent Accident Reimbursement

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
 
Reimbursement Offered
Up to the first $500 of out-of-pocket costs
 
How to Apply
Application must be received no later than 3-months after the end of the plan year in which the accident occurred
Complete a Dependent Accident Reimbursement Form Download
Attach a copy of the Explanation of Benefits (EOB)
It must show the accident claim
Mail both documents to the Health Plan Administrators Office
 
What Next
If approved, the Claim will be re-processed
The Health Plan will pay the Provider any amounts owed
The Provider will reimburse the Member any amounts owed