If your dependent child works and has their own health benefits, they are still covered under the MTA plan until they reach their 26th birthday, even if they are married (Affordable Care Act).
- Make sure you inform MTA insurance companies (medical & hospitalization) that your child has their own coverage. That becomes their primary plan.
- The MTA plan will now become their secondary plan.
- When they go to a Doctor or Hospital, they should produce both ID cards and inform the billing manager they are covered by 2 plans.
- Many Doctor offices will bill primary first and any remaining fees (including co-pays) will be billed to the secondary plan (MTA).
- If your child must pay the co-pay, they can submit for reimbursement.
- The secondary plan will most likely send a check to the Doctor, which would get you a credit at the Dr. office. Or you can ask for a refund from the Doctor office.
- If they pay a co-pay, get a Health Claim form from the Doctor/hospital showing the insurance code and diagnosis. Hold onto this and submit with the EOB from the primary insurance company.
- For hospital charges not covered, follow the same process below but submit to Blue Cross/Blue Shield (with their form).
For dependent children to file for reimbursement of out of pocket expenses at a Physicians office: Wait until you get an EOB (explanation of benefits) from the primary insurance company, then send a copy of that with a copy of the Dr. office claim form, attach both to the United Healthcare claim form (link below) and mail all three to the address on the form or fax. This form is only for Empire/United Healthcare. If you have a different insurance carrier, you must use their form.
The same goes for prescription co-pays. Fill out the form with a copy of the drug store receipt and drug info numbers/dose, etc. Send it in with the form in the following link.