June 29, 2007                                                                   Bulletin #20

REMINDER TO BLUE CROSS/BLUE SHIELD TRADITIONAL 901 SUBSCRIBERS ONLY

RE: PRESCRIPTION CO-PAY REIMBURSEMENT

          You must submit your prescription receipts between July 1, 2007 and July 31, 2007, for prescription co-pay reimbursement. These receipts should be dated July 1, 2006 through June 30, 2007. Please send receipts to:

P & A Administrative Services, Inc.

Attn: Amy McCarthy

17 Court Street, Suite 500

Buffalo, New York 14202

MAJOR MEDICAL DEDUCTIBLE – $500/$1,000

SUBMIT BLUE CROSS/BLUE SHIELD

“Explanation of Benefits” STATEMENTS TO:

P & A Administrative Services, Inc.

Attn: Amy McCarthy

17 Court Street, Suite 500

Buffalo, New York 14202

716-852-2611, ext. 245

          The City of Buffalo is self-insured which brings the Major Medical $500/$1000 deductible down to the $100/$200 limit.

I have attached a sample highlighted copy of the “Explanation of Benefits” form for your information. Please note that you should only submit those forms which show a dollar amount in the deductible column. You will not be reimbursed for any amount shown in the “Coinsurance” or “Other” columns. Once you have met any portion of the deductible ($100 single, $200 for family) you are entitled to receive some reimbursement.

Explanation of Benefits Form.pdf