What is the turnaround time for claim reimbursment under the trust?
Upon receipt of a valid claim for reimbursement (including supporting documentation), typically it will be reviewed for coverage and authorized for payment through the trustee within 30 days, often much sooner. In the rare instance reimbursement is delayed beyond 30 days, written notice will be provided with any outstanding requirements.
What trust agreement provisions dictate what is covered for the beneficiary's medical care and/or special education services?
Generally, the "allowable benefits" section of the trust outlines specifically what is covered. Furthermore, these allowable benefits must be necessary and reasonable and exclusively for the benefit of the beneficiary, unless otherwise specifically authorized by the terms of the trust.
How does the Advisor/Administrator of the trust determine whether or not a request for payment is authorized?
Upon receipt of the request for payment and any required documentation, authorizations, or releases, the Advisor/Administrator will commence its review of each request for payment of allowable benefits and make a determination as to whether the goods or services for which payments being sought are allowable benefits under the terms of the trust. The Advisor/Administrator may be guided in the determination process of what is " necessary and reasonable" by making reference to what would be a deductible medical expense under the Internal Revenue Code.
What is an EOB (Expanation of Benefits) and why are they relative to provider payment or reimbursment?
The trusts are established for the purposes of paying allowable medical beneifts that are not otherwise paid for by other benefit sources (i.e insurance). The EOB's issued by those other sources assist us in determinting the extent of their payment, if any, before authorizing the trustee to make payment from the trust.
Who should I contact about claim reimbursment status, MFA or the trustee of my trust?
Always contact Medical Fund Advisors (MFA) and we will provide the latest status.
How are trust requests and benefits effected when my child (the beneficiary) reaches the age of majority?
When a beneficiary reaches the age of majority, the issue of competency must be considered. Since any prior guardianship is no longer legally valid once the age of majority is reached, guardianship may need to be established once again in order for the trust benefits to continue. Contact can be made with your county court to find the procedures necessary in your area. If a beneficiary is incompetent, legal documents must be filed in the appropriate state, and a guardian/conservator assigned. The guardian/conservator will then be the contact person for all trust benefits. Absent a valid guardianship beyond the age of majority, the beneficiary will be deemed competent and all contact (benefit requests and payments) will be conducted through him/her.
How can I get reimbursed for allowable expenses that I advanced paid?
Go to the Forms section of our site, login, and submit the approprate form for your situation. If you forget the login name and password, please contact us by phone at 800.359.0048.
Where can I obtain more information regarding MFA's services, including fees?
Please contact us for further information.