Text Size:  A  A  A

FAQ

The answers to frequently asked questions below are general in nature and do not modify the terms of their respective Plans. You should refer to the related Summary Plan Description for more specific information regarding each Fund's Plan.

Top Frequently Asked Questions

If a claim submitted is more than my available MRP balance, will the remainder be reimbursed once additional funds are obtained?

No. You would have to resubmit the claim again to receive the unreimbursed balance. You would need to complete a new MRP Claim form and submit the original explanation of benefits you received from the Fund Office.

Reminder: Claims must be submitted no more than 12 months from the date of service

Can claims incurred while I’m enrolled in a Plan C option (C1, C2, C3, C4, MRP or Triple S) be reimbursed if I am now in the Retiree only MRP Plan?

No. A claim must be incurred after the effective date of your enrollment in the R-MRP Plan and during a period that you are still enrolled in the R-MRP Plan for reimbursement from your R-MRP Plan.

What happens if I’m enrolled in the MRP stand-alone option and I don’t utilize the funds in my account?

If there is no activity (contributions received, claim(s) paid, or premium charges) within the past 8 quarters, then all contributions are forfeited. 

How do I submit the MRP Claim form and support documentation to the Fund Office?

You may submit the claim to the Fund Office in one of four ways:

  • By logging on to your website account at www.iatsenbf.org. Scan your document(s) and upload (no MRP claim form is required when uploading via the website)
  • By email as a PDF attachment to claims@iatsenbf.org
  • By Fax to: 646-783-7650
  • By Mail to:

I.A.T.S.E. National Benefit Funds, MRP Claims Department

417 Fifth Avenue, 3rd Floor

New York, NY  10016

You can check the status of your MRP claim by going to our website and logging into your account.

If I incurred claims for which I want reimbursement, do I have to be enrolled in the MRP option to make a claim?

Yes. You must be enrolled in the stand-alone MRP option at the time of the claim submission. If you are covered under Plan C1, C2, C3 or C4 and have excess funds in your CAPP account available for reimbursement, then you can submit for reimbursement of claims incurred as long as they are submitted within the 12 month filing deadline. 

What documentation do I need in order to submit my eligible expenses for reimbursement?

You need to complete a Medical Reimbursement claim form (signed and dated) for each patient (including any dependent enrolled in an employer or union sponsored group health coverage plan that meets the ACA minimum value standard) along with supporting documentation for each expense such as an itemized bill from the provider and the Explanation of Benefits (EOB) from your insurance carrier.

If you are submitting through the website at www.iatsenbf.org:

  • You do not need to complete a claim form however all of the above will be required and you will also be required to check off a box certifying the following:
    • The submitted expenses have not been previously reimbursed and are not reimbursable under any other health plan coverage
    • The submitted expenses are qualified medical expenses as defined by the Internal Revenue Service under IRS Publication 502 (as described in our MRP Guidebook)
    • The submitted expenses are for a dependent enrolled in an employer or union sponsored group health coverage plan that provides minimum value (effective January 1, 2017)
    • If the reimbursements requested are for health insurance premiums, that those premiums were paid on a post-tax basis (eg. Not through a pre-tax flex spending account or pre-tax deductions made by you or your spouse’s employer through payroll deductions).
    • That all the information you have provided in support of the claim you are submitting is complete, true and correct and all charges for which you are requesting reimbursement were paid by you or your dependent, where applicable.

Please note: You must be enrolled in the Plan C-MRP both when the expense is incurred and when you submit a claim for reimbursement. To be eligible for reimbursement under the Plan C-MRP, your expense must be a qualified post-tax medical coverage premium or appear on the list of qualified unreimbursed medical expenses. Please refer to the Medical Reimbursement Guidebook for Plan C  and Plan R-MRP SPD  for a list of qualified expenses.


1 2 3 4 5 6 7 8 9 10 11 12