Hospital Grant for Union Plus Credit Card cardholders
- You must be a Union Plus Credit Card cardholder or Teamster Privilege Credit Card cardholder in good standing.
- You must have been a Union Plus Credit Cardholder or Teamster Privilege Credit Card cardholder for at least 3 consecutive months.
- You must complete the required application and provide documentation to the Plan that you or a member of your household had unreimbursed hospital expenses that:
- are associated with a hospitalization event(s) that took place during the 12 month period prior to the date that you submit an application for a Hospital Grant, but at least 3 months after you became a Union Plus or Teamster Privilege Credit Card cardholder; and
- are equal to 10% or more of your annual income.
- You must provide documentation of your annual income by supplying your most recent Form W2 or pay stubs covering the applicable period.
- You must provide the applicable hospital and insurance statements that document:
- the dates and charges for the hospitalization (“Hospital Charges”)
- the amount of the Hospital Charges covered by insurance; and
- the amount of Hospital Charges for which the patient was financially responsible.
- You may only receive one Hospital Grant for any one Union Plus or Teamster Privilege Credit Card account. If you have multiple Union Plus or Teamster Privilege Credit Card accounts, you can only receive one Hospital Grant for any unique hospitalization event.
Eligible hospital expenses:
- When you calculate your out-of-pocket hospital expenses, you may include the insurance deductibles, any hospital charges, physician charges, medications and other medical expenses incurred during the hospitalization.
- Include only those hospital expenses related to an event resulting in hospitalization that occurred within 12 months prior to your application.
- Do not include expenses that were covered by your (or your spouse/dependent’s) health insurance.
- Do not include expenses from care before or after the time of hospitalization.
- Unreimbursed expenses must total at least 10% of your annual income.
How to apply
- Collect the following:
- Documentation for your income (tax return(s) or W-2s for the last year)
- Hospital bills, insurance Explanation of Benefit (EOB) forms. Make sure you have documentation for all periods of hospitalization and explanation of insurance benefits for all coverage you received.
- Complete the online application form.
- Print the online application PDF, sign and mail all required documentation to:
ATTN: Union Plus Hospital Grants
1100 1st Street, NE, Suite 850
Washington, DC 20002
- Please allow 6-8 weeks for application processing. You will notified by mail when your application has been approved or denied.