Medical Claim Flow

Text-only Claim Flow Diagram


Medical Claims (doctor, hospital, clinic, therapy, durable goods) for One Person, Starting July 1.

From $1 to $1000

  • Member’s responsibility. Amounts will accumulate to deductible.
  • Member can submit claims to Mid-America for HRA reimbursement. District contributes $750 single/$1500 family per year. Roll-over amounts are available as well.

From $1,001 to $3,000

  • Security Health Plan submits claim to EBC, which is the HRA administrator for the District.
  • EBC will pay provider directly.
  • Unused funds will not roll over.

$3,001 and over

  • Security Health Plan pays provider.
  • For the rest of the plan year, doctor, clinic and hospital expenses will be paid in full.

Medical and RX claims accumulate towards the deductible together.

 

Prescription Drug Claims at the Pharmacy for One Person, Starting July 1.

 

From $1 to $1000

  • Member’s responsibility and member will make payment at pharmacy. Amounts accumulate to deductible.
  • Member can submit claims to Mid-America for HRA reimbursement. District contributes $750 single/$1500 family per year. Roll-over amounts are available as well.

From $1,001 to $3,000

  • Member will make payment at pharmacy.
  • Security Health Plan submits claim to EBC
  • EBC will reimburse the member by check or auto-deposit.
  • Unused funds will not roll over.

$3,001 and over

  • Member is responsible for copays of $10/$30/$60/25%
  • Once member has incurred $1000 of copays, Security Health Plan will pay 100% of prescription costs.
  • Remember to show your ID card at the pharmacy EACH time, even if you haven’t met your deductible yet.

Medical and RX claims accumulate towards the deductible together.

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