OFFICIAL POSTING

SBAGNE EMPOWERMENT BENEFIT 2016

Who Qualifies?What is a QA?

A Qualified Applicant (QA) is ayouth with Spina Bifida, birth through age 18who resides in the SBAGNEservice area (Massachusetts, New Hampshire, Maine & Vermont).The QAmust be a resident of the SBAGNEservice area for a minimum of 6 months in the calendar year.

How much is the benefit?

  • The amount, available number and qualifications for the calendar year are determined by the SBAGNE’sBoard of Directors at the Annual Meeting of the prior year. The benefits will be determined by the Board of Directors based on the proposed budget for each calendar year and shall be reflected in the Annual Empowerment Flyer revised for each calendar year.
  • Families with more than one youthwith Spina Bifida are eligible to apply for the benefit amountfor each youth with Spina Bifida.
  • SBAGNEreserves the right to revise this policy annually in accordance with its resource availability.

For the a copy of the OFFICIAL POSTING and/or APPLICATION log onto , or Questions email or call Ellen Heffernan-Dugan at or 1-888-479-1900

What Kinds of Expenses Qualify?The benefit maybe used to reimburse for adaptive equipment; camp, adaptive sports and recreation equipment; urological supplies for individuals over the age of 3; durable medical equipment and assistive technology.

When Should I Apply for Benefits?

Only one application per year, per individual will be accepted. Applications will be reviewed on a monthly basis, beginning July 31, 2016. The 2016 program will be available to constituents until all Empowerment Program funds are depleted.

Distribution of Benefits:

Our goal is to allow each approved applicant to receive a benefit award. For 2016each individual may apply for a maximum benefit award of $200.

Emergency situations may be considered, at the discretion of the SBAGNEBoard of Directors. Please contact Ellen Heffernan-Dugan for additional information.

How do I Apply for Benefits?

The QAmust do the followingor the application will not be approved:

  1. Complete an official SBAGNE Benefits application.
  1. Application must include a statement of disability from physician, including address and telephone number of physician. If you have provided this information in previous years SBAGNEhas it on file and it is not required .A detailed medical history is not needed.
  1. Provideproof of eligible expenses:

Direct Pay Only:

The QA provides, in advance of receipt of item or service, a bill for an

eligible expense that you want paid by your benefit. Once these receipts are received and

approved, SBAGNEwill write acheckdirectly to the third party for the expense. Individuals/Families will not be paid directly. SBAGNE will provide the applicant evidence of payment made.

SBAGNE Action:

  1. Upon receipt, the Executive Director will:
  2. Review the application in accordance with the current guidelines;
  3. If incomplete, ED will send out letter to the applicant and wait for further response to complete the application.
  4. In accordance with an approved application, the Executive Directorwill:
  5. Send the direct payment to the provider with a copy of the correspondence to the person/parent.
  6. If the application is denied, a letter of explanation will be mailed to the applicant within 5 working days. The QA may resubmit an application correcting any deficiencies.
  1. The SBAGNEdoes not exclude any youthfrom our service area from applying for benefits unless the applicant does not have Spina Bifida.

SBAGNE Official Posting for Annual Benefits

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