Claims Generally

EWTF requires that a written claim for benefits be made either by you or a representative authorized by you. Often, a claim will be filed by your doctor's office staff, particularly if your doctor is a member of OneNet Preferred Provider Network.

Under the Plan of Benefits adopted by the Board of Trustees, only certain medical and related benefits are payable.  Some medical treatment falls outside the scope of the Plan of Benefits approved by the Board of Trustees and will, therefore, not be paid by the Fund.

Furthermore, in order to qualify for coverage under the Plan of Benefits, a participant or beneficiary must be "eligible". If a participant or beneficiary loses eligibility, then later claims or benefits will not be allowed under the terms of the Fund.  The definition of Beneficiary, for the purposes of this section, is a spouse or dependent.

Furthermore, claims presented to the Fund are only payable if the participant or beneficiary follows the Fund rules for submission of claims.  These rules are set forth in your Summary Plan Description.

Finally, certain benefits are payable under the terms of the Fund only if they are medically appropriate, which may depend upon the medical opinions and judgment of doctors. The Board of Trustees may consult with doctors from time to time to determine whether certain medical treatment is covered as medically necessary or otherwise appropriate medical treatment under the terms of the Fund.