Already have outside insurance? Our supplement plans enhance your existing medical coverage at no additional cost.
Supplemental Coverage
What are the supplemental plans?
THT currently offers two supplemental plans for members who already have health coverage through their spouse or other means. These plans enhance your existing health coverage at no extra cost to you. The following supplemental plans are not full coverage health plans or replacements to a medical plan.
Members on these plans can select a dental and/or vision plan (additional premium may apply), or waive dental and/or vision.
Hospital Supplement Plan
You will get reimbursed $500 per day for each day you’re hospitalized or under 24-hour observation, up to an annual maximum of $10,000.
Eligibility
- All active/suspended employees and COBRA participants are eligible
- Dependents are eligible
- Retirees are not eligible
Benefits
- Eligible Facilities –
- Hospital (inpatient, outpatient, ER, observation)
- Ambulatory Surgical Facility
- Skilled nursing, rehab, hospice, dialysis, and mental health facilities
- Optional enrollment in THT Dental Coverage (HMO or PPO, additional premium may apply)
- Optional enrollment in THT Vision Coverage (Standard or Plus, additional premium may apply)
Reimbursement process
- Submit an itemized facility/hospital bill, charge sheet or Explanation of Benefits (EOB) via the
- Teachers Health Trust Member Portal within 12 months of discharge.
- Claims are processed within 60 days.
- Payments are made directly to participants.
Exclusions
- Non-facility stays (e.g., office visit or home visits)
- Non-itemized or untimely submissions
Spousal Supplement
This plan reimburses in-network copays, deductibles, and coinsurances for eligible employees and their eligible dependents who receive medical and pharmacy benefits as a dependent on their partner’s plan. Members on this plan will no longer have to worry about the cost of copays, coinsurance, and deductibles when seeing an in-network provider under their primary medical plan.
Eligibility
- All active/suspended employees who are covered as a dependent on their partner’s insurance (must not be a THT or CCSD plan, and cannot be classified as a “Qualified High-Deductible Health Plan”).
- Employees who are COBRA participants are eligible.
- Employees may enroll their eligible dependents who are also covered on the eligible employee’s partner’s insurance.
Benefits
- Reimbursement for In-network copays, coinsurances, and deductibles for medical and pharmacy services.
- Optional enrollment in THT Dental Coverage (HMO or PPO, additional premium may apply)
- Optional enrollment in THT Vision Coverage (Standard or Plus, additional premium may apply)
How to Enroll
- Enroll in the plan during Open Enrollment or a special enrollment period (this waives THT medical coverage).
- Send your THT Certificate of Coverage (COC) to your spouse/partner’s HR.
- Complete this within 30 days of waiving THT coverage
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Submit EOBs to THT for reimbursement, along with:
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COC from spouse’s insurer
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Primary insurance ID card
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Marriage certificate
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Children’s birth certificates (if applicable)
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Medical Reimbursement Process
For your first submission, include a copy of the primary medical ID card. Then, simply upload your EOBs through the Member Portal for quick reimbursement. —THT handles the rest!
Pharmacy Reimbursement Process
You received a coordination of benefits card from Teachers Health Trust. Please give this card to the pharmacy at the same time you give your primary insurance card to them. The pharmacy will run your claim through your primary, and then through the Teachers Health Trust card. You should not owe anything for prescriptions that are on the primary’s formulary.
If for any reason pharmacy benefit does not coordinate, please submit Pharmacy receipt with description, pharmacy name, and direct reimbursement form through your member portal for reimbursement. Documents must be uploaded within 12 months of date on receipt.
