Plan Summary
EUTF Supplemental Medical & Prescription Drug Plan
This EUTF supplemental plan provides reimbursement of eligible out-of-pocket medical expenses for active employee-participants who are primarily covered under a non EUTF health plan.
Plan Year: 7/1/2021 – 6/30/2022 (Download Document)
Schedule of Benefits
Plan Type: Group supplemental medical and prescription drug plan is a secondary payer.
Plan Year Maximum: $2,750 per covered participant | Prescription Drug Sublimit: $250 per covered participant
Prescription Drug Benefit:
The maximum reimbursement for prescription drug copayment charges is $20 per 30-day supply, $40 per 60-day supply, and $60 per 90-day supply. Reimbursements for prescription drug copayment charges shall not exceed $250 per plan year per covered participant. Reimbursements for prescription drug copayments count towards the $2,750 Plan Year Maximum.
Eligible Medical Expenses: Those out-of-pocket medical, hospital and surgical expenses listed under Covered Expenses. Some exclusions apply.
Covered Expenses
| Preventive Care
• Colorectal Screening |
Physician Services
• Consultations |
| Hospital and Facility Services
• Ambulatory Surgical Center |
Other Services
• Ambulance |
| Testing
• Allergy Testing |
Chemotherapy and Radiation Therapy |