The information below is a Summary of Material Modification to the Voluntary Hospitals
House Staff Benefits Plan that will apply to the 2019 Plan year that started July 1, 2019 and will
end June 30, 2020 and the 2020 Plan year that will start on July 1, 2020 and will end on June 30,
2021.
After consultations with VHHSBP participants concerning the impact of the Medical
Plan Changes raising the Individual Out of Network Annual Deductible from $100 to $1,000 that
was effective on October 1, 2019, the Trustees have adopted a reimbursement program for the
2019 and 2020 VHHSBP Plan years that will allow participants to obtain reimbursement from
the Plan for Out-of-Network medical expenses that would have been paid by the Plan under the
$100 Annual Individual Out-of-Network deductible in place prior to October 1, 2019 but were
not paid because the new $1,000 Annual Individual Out-of-Network deductible had not been
satisfied. Effective retroactively to July 1, 2019, medical expenses covered by the Plan that were
not paid because the $1,000 Annual Individual Out-of- Network deductible has not been satisfied
will now be eligible for reimbursement from the Plan upon submission of copies of an Empire
Explanation of Benefit (EOB) where the $1,000 Annual Individual Out-of-Network was applied
and proof of payment must be submitted to the Plan within one hundred twenty (120) days after
the end of the Plan year.
Please note that this Individual Out-of- Network Reimbursement will not apply to any
medical expenses that are incurred after June 30, 2021 and will not apply to medical expenses
that are not submitted for reimbursement after one hundred twenty (120) days after the end of the
Plan Year in which the expenses occurred.
Please also note that the Plan urges all participants to seek medical care from In Network
providers both because it is less expensive for participants and the Plan. You may obtain
information on which hospitals, doctors and pharmacies are In-Network by consulting Empire
for the latest information on medical providers that are In Network.
Finally, the reimbursement program is applicable only to the Individual Annual Out-of-
Network deductible and not to any other deductible, co-insurance or annual Out-Of-Pocket term
of the Plan.
