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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.

• Medical reimbursement form
• Claims procedure calendar
• Reimbursement account online access

• 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.