CSEA prescription drug co-pay benefits info

CSEA members who are enrolled in the Empire Plan or an HMO are entitled to reimbursements for NYSHIP prescription drug card co-pays and covered prescriptions less than the co-pay once annually, up to a maximum of $150 per family per calendar year.  To obtain the maximum benefit of $150, members must wait until their co-pay expenses reach $450 before filing a claim. For purposes of the Prescription Drug Co-pay Benefit, “Family” includes Domestic Partner.

  • Members who are enrolled in the New York State Health Insurance Program (either the Empire Plan or Health Maintenance Organization) are entitled to a reimbursement once annually for NYSHIP prescription drug co-pays for themselves and their eligible dependents.
  • Only one claim per calendar year (January – December) is processed.  To obtain the maximum benefit, wait until your co-pay expenses reach $450.00 before filing your claim.
  • If you do not accumulate $450.00 before the end of the year, submit your claim after December 31 for what you did pay over $300.00.

The Deadline for submission is March 31 of the following year for the co-pays accumulated during the previous calendar year. Therefore, for 2017 the deadline is March 31, 2018.

Submit your completed form with itemized pharmacy printout clearly indicating the patient name, co-pay amount, and prescription drug names, along with a photocopy of your Empire Plan or HMO insurance card. Cash register receipts, canceled checks and credit card receipts are not acceptable. The fund will then send the check to the member.  Prescriptions must be dispensed by a licensed pharmacist.

To obtain more information and print the form go to this website:  https://www.cseaebf.com/state_benefits.php