Detectives’ Endowment Association, Inc. member benefits website — Scott Munro, President

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Catastrophic

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Catastrophic Benefits for Retired Members of The Detectives' Endowment Association

There are two parts to the DEA Catastrophic Benefit.

FIRST PART:

Is a self insured benefit through the DEA for members who have Emblem Health/GHI as their medical carrier. There is a $4,000 deductible per calendar year. The procedure for applying for DEA catastrophic is as follows:

  • Claims for non-participating doctors are submitted through GHI for their basic allowance. Because Emblem's payment schedule is so low the member always has a out of pocket expense. When the difference between what your doctor charges and what Emblem allows exceeds $4,000 you qualify to apply for the DEA Catastrophic benefit.

EXAMPLE: Bills submitted to Emblem are for $20,000, Emblem’s basic allowance is $5,000, your responsibility is the remaining $15,000. You would send your Emblem statement (EOB) showing the above to the DEA, we would process the claims under the DEA Catastrophic Benefit. Of the remaining $15,000 out of pocket expense*** we would minus the $4,000 deductible and then send you a check for the balance.

MAXIMUM LIFETIME BENEFIT PER FAMILY IS $250,000

*** Please be advised that if Emblem does not make an allowance for services rendered that specific service will not be included in the calculations for catastrophic coverage.****

You must exceed $4,000 before the second part of the DEA catastrophic benefit will be applied.

SECOND PART:

DEA will refund $3,000 from the $4,000 deductible.