The House Staff Supplemental Fund (FUND) was established to help alleviate the financial burden of house staff with high out-of-pocket medical expenses for themselves and covered family members when those expenses are applied to the out-of-pocket maximum of the Student Health Program (SHP).
The SHP out-of-pocket limit is $3,000 per individual with a cap of $9,000 per family each plan year (July 1 – June 30). The FUND will reimburse the house officer for SHP deductibles and coinsurance amounts for eligible expenses paid by the house officer exceeding $1,000 per person or $3,000 per family that are applied to the SHP out-of-pocket maximum. This means that the FUND will reimburse the house officer up to $2,000 for an individual or $6,000 for a family per plan year (July 1 – June 30).
If you have paid for medical care for yourself or an eligible family member during the plan year and the amount you paid (up to the SHP Allowed Benefit) exceeds $1,000 for an individual or $3,000 for the family, you can apply for reimbursement from the FUND. Claims for review and approval can be submitted to the FUND claims office any time during the plan year but no later than December 31st following the end of the plan year. The plan year begins on July 1 and ends on June 30.
The SHP out-of-pocket limit does not include charges that exceed the Allowed Benefit amount, balance billing charges for out-of-network providers, prescription copayments, expenses not covered by the SHP, penalties for failure to obtain pre-authorization when required by the SHP, and amounts paid for ART treatment. Even though you pay these expenses, they do not count towards the SHP out-of-pocket maximum.
To apply for reimbursement, you must submit the SHP Explanation of Benefits (EOB) for all claims incurred during the plan year with proof that you paid those expenses to the providers. Reimbursement claims are processed by the University Health Services (UHS) on behalf of the FUND. For more information, please contact UHS by calling 410-955-3872.