Reimbursement: What to Know

Our financial assistance programs help eligible individuals with out-of-pocket expenses related to treatment. Financial assistance is provided on a calendar-year basis, and patients must reapply during the fourth quarter of each year.

If you are enrolled in a TAF copay assistance program, and you paid out of pocket for your copayment, refer to the Prescription Medication Copays section below and submit the required documentation to be reimbursed.

Reimbursement Categories

TAF financial assistance programs provide reimbursement for eight types of out-of-pocket expenses. To learn which categories are included in your disease program, visit enroll.tafcares.org or call us at (855) 845-3663. Read below to see what documentation is required for reimbursement and what details must be included on each document.

Health Insurance Premiums

Sample Master Plan Document Sample Proof of Payment

Some TAF programs provide reimbursement for monthly health insurance premiums. To be reimbursed each month, please submit supporting documentation and proof of payment.

Accepted Proof of Payment:

  • Payment confirmation from your insurer
  • Bank statement
  • Pay stub from your employer
  • Front and back of a canceled premium payment check

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We cannot accept the following documents:

  • Handwritten receipts
  • Money orders
  • Cashier’s checks
  • HSA, HRA, or FSA health plans

The following must be included in the supporting documentation of every health insurance premium reimbursement request:

  • Your name or the primary beneficiary’s name
  • The name and logo of the insurance company, bank, or employer
  • The amount paid toward the premium
  • The date the premium was paid/deducted
  • The pay period (only if submitting an employer pay stub)

Summary of benefits and coverage: Each year you must submit a document that clearly summarizes the key features of your health insurance plan with your initial reimbursement request. Your insurance company may refer to this document by several different names. Some examples are: health insurance benefit statement, health insurance plan details, summary of benefits, insurance plan detail, employer benefit summary, or master plan document. You must also submit this document if you change health insurance plans during the year.

This documentation must include:

  • Plan type
  • Individuals covered under the plan
  • Coverage period (plan’s start and end dates)
  • Premium amount
  • Premium frequency
    (e.g., weekly, monthly)

Note: Coverage must include the names of every individual covered under the plan along with the person-by-person cost breakdown.

Prescription Medication Copays

Sample Proof of Treatment Sample Proof of Payment

Some TAF programs provide reimbursement for prescription medical copays, deductibles, and coinsurance for the disease named in the program.

If you received your prescription from a pharmacy, submit a receipt.

If you received your prescription from a site of care, submit both your explanation of benefits and your health insurance billing claims form (UB-04).

Accepted Proof of Treatment

All documentation must contain:

  • Name of medication
  • Date the prescription was filled
  • Total cost matching proof of payment

Proof of treatment must include:

  • Business name and logo
  • Patient name
  • Date of service
  • Treatment name
  • Total treatment cost
  • Amount paid by your plan
  • Amount you paid

Accepted Proof of Payment

Acceptable documents (submit one):

  • Paid billing invoice
  • Receipt with date the prescription was filled
  • Bank statement with logo

Proof of payment must include:

  • Date the transaction was made
  • Business name and logo
  • Name of the medication
  • Total cost

Therapy Administration

Sample Proof of Treatment Sample Proof of Payment

Some TAF programs provide reimbursement for therapy administration costs for all FDA-approved treatment for the disease named in the program.

Accepted Proof of Treatment

Acceptable document examples include:

  • Health insurance billing claim form (UB-04) or billing invoice from the site of care
  • Explanation of benefits from an insurer

Proof of treatment must include:

  • Business name and logo
  • Patient name
  • Date of service
  • Name of treatment/infusion
  • Amount paid

Accepted Proof of Payment

Acceptable documents (submit one):

  • Paid billing invoice
  • Receipt with date the prescription was filled
  • Bank statement with logo

Proof of payment must include:

  • Date the transaction was made
  • Business name and logo
  • Name of the medication
  • Total cost

Disease Management (including prescribing-physician copays, coinsurance, and deductibles)

Sample Proof of Treatment Sample Proof of Payment

Some TAF programs provide reimbursement for approved tests, exams, and appointments related to FDA-approved treatment for the disease named in the program. Documentation must include the date of service, copay amount, and the specialist’s name. To see which specialists are eligible in your program, call us at (855) 845-3663. If an explanation of benefits is unavailable for a proof of treatment, you may submit an after-visit summary along with a proof of payment that specifically lists the cost of the office visit.

Accepted Proof of Treatment

Acceptable document examples include:

  • Health insurance billing claim form (UB-04) or billing invoice from the site of care
  • Explanation of benefits from an insurer

Proof of treatment must include:

  • Business name and logo
  • Patient name
  • Date of transaction was made
  • Disease name or reason for visit

Accepted Proof of Payment

Acceptable documents (submit one):

  • Paid billing invoice
  • Receipt with date the prescription was filled
  • Bank statement with logo

Proof of payment must include:

  • Date the transaction was made
  • Business name and logo
  • Name of the medication
  • Total cost

Treatment-related Travel

Sample Proof of Travel (Flight)

Some TAF programs provide travel allowances only to sites-of-care for therapy administration and visits to specialists. To see which specialists are eligible in your program, call us at (855) 845-3663. All reimbursements must be related to FDA-approved treatment, appointments, or office visits related to the disease named in the program. All meal receipts must be itemized. TAF does not provide reimbursement for any alcoholic beverages. The transaction date must match the date(s) when the treatment was received. If an explanation of benefits is unavailable for a proof of treatment, you may submit an after-visit summary along with a proof of payment that specifically lists the cost of the office visit.

chart containing treatment-related travel reimbursement information

Accepted Proof of Treatment

Acceptable document examples include:

  • Health insurance billing claim form (UB-04) or billing invoice from the site of care
  • Explanation of benefits from an insurer

Accepted Proof of Payment

Acceptable documents (submit one):

  • Paid billing invoice
  • Receipt with date the prescription was filled
  • Bank statement with logo

Proof of payment must include:

  • Date the transaction was made
  • Business name and logo
  • Name of the medication
  • Total cost
  • Patient Name

Genetic Testing

Sample Proof of Treatment Sample Proof of Payment

Some TAF programs provide reimbursement for genetic testing for the disease named in the program.

Accepted Proof of Treatment

Acceptable document examples include:

  • Health insurance billing claim form (UB-04) or billing invoice from the site of care
  • Explanation of benefits from an insurer

Proof of treatment must include:

  • Business name and logo
  • Patient name
  • Date of service
  • Name of service provided
  • Amount paid

Accepted Proof of Payment

Acceptable documents (submit one):

  • Paid billing invoice
  • Receipt with date of the genetic testing
  • Bank statement with logo

Proof of payment must include:

  • Date the transaction was made
  • Business name and logo
  • Name of the genetic testing
  • Total cost

Emergency Services

Sample Proof of Treatment Sample Proof of Payment

Some TAF programs provide reimbursement for medical transport services, emergency medical services, emergency department visits, and emergency room visits (up to $200/claim).

Accepted Proof of Treatment

Acceptable document examples include:

  • Health insurance billing claim form (UB-04) or billing invoice from the site of care
  • Explanation of benefits from an insurer

Proof of treatment must include:

  • Business name and logo
  • Patient name
  • Date of service
  • Name of ambulatory services received
  • Amount paid

Accepted Proof of Payment

Acceptable documents (submit one):

  • Paid billing invoice
  • Receipt with date for the ambulatory services
  • Bank statement with logo

Proof of payment must include:

  • Date the transaction was made
  • Business name and logo
  • Name of the ambulatory services
  • Total cost

Diagnostic Lab Tests

Sample Proof of Treatment Sample Proof of Payment

Some TAF programs provide reimbursement for diagnostic lab tests for the disease named in the program. To see the full list of covered diagnostic lab tests and their CPT codes, call us at (855) 845-3663.

Accepted Proof of Treatment

Acceptable document examples include:

  • Health insurance billing claim form (UB-04) or billing invoice from the site of care
  • Explanation of benefits from an insurer

Proof of treatment must include:

  • Business name and logo
  • Patient name
  • Date of service
  • Name of the diagnostic lab test
  • Amount paid

Accepted Proof of Payment

Acceptable documents (submit one):

  • Paid billing invoice
  • Receipt with date of the diagnostic lab tests
  • Bank statement with logo

Proof of payment must include:

  • Date the transaction was made
  • Business name and logo
  • Name of the diagnostic lab tests
  • Total cost