Reimbursement procedures

The Miami Association of Firefighters Health Benefit Trust was designed to provide for reimbursement of qualified medical claims for members, their spouses, and dependents.  The request for reimbursement must include the “Medical Reimbursement Form”, signed and dated by the member, and all supporting documentation.


Diversified Administration, Inc.
6161 Washington Street
Hollywood, Fl. 33023
Office: (954) 983-9970 
Fax (954) 983-9695
Website: www.div125.com
Email: claims@div125.com

  • 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.
  • Medical reimbursement claims may be subject to a review by the Administrator of the Fund.  In order to streamline the reimbursement process, and absent of any unforeseen circumstances.
  • 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.

     
  • 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.
  • If any information or supporting documentation is missing from the claim, the member will be notified via telephone and/or in writing (if necessary) and given the opportunity to provide such information.

  • 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.

 
 
2020 - Miami Association of Fire Fighters Health Benefit Trust