Section 2-5 - Acceptance of Claims (a) Claims for medical assistance: - (i) A State licensed medical provider or miner shall submit claims for benefits directly to the Board's third-party administrator on a standard health insurance claim form or other forms acceptable to the third party administrator.
(b) Claims for Prescription Drug Assistance: - (i) A qualified miner covered by insurance providing prescription drug coverage may submit pharmacy receipts accompanied by a claim form with the miner's name and mailing address to the Board's third-party administrator. The miner's out-of-pocket costs for covered prescriptions shall be paid directly to the miner.
- (ii) Qualified miners with no insurance may request a Prescription Hardship benefit. The Board shall determine the benefit on a case by case basis and the miner will be issued a Miner's Hospital Prescription Benefit Card that allows pharmacies to charge the entire cost of covered prescriptions, up to the annual maximum allowed under Section 2(a), to the Board. The prescription hardship benefit must be renewed every October.
(c) Accepted claims will only be paid if budgeted funds are available. Once the funds budgeted for the biennium are exhausted, no further claims for services provided during that biennium will be paid.
(d) All claims for a calendar year must be received on or before June 30 of the following.
(e) Claims received but not accepted or paid due to lack of budgeted funds may not be resubmitted.