Catastrophic Benefits Revisited

By John Puglissi, PBA First Vice President

t's been four years since I first wrote a column in this space on how to file for catastrophic benefits, which are available to active members and their eligible dependents who are enrolled in GHI through the New York City Health Insurance Program. The benefit is designed for those members who use non-GHI participating medical providers.

While 67% of our members are enrolled in GHI, we have found recently that fewer and fewer medical providers are accepting that plan these days — especially as you get farther and farther away from New York City. Nevertheless, people fighting serious or catastrophic illness are understandably inclined to seek medical help from specialists, who are frequently out-of-network. And that's just when the PBA catastrophic benefit comes into play.

Here's how GHI-enrolled members who have used non-GHI participating providers can avail themselves of the benefit:

After the member and/or dependent have incurred out-of-pocket expenses of at least $1,500 ($1,250 if the member is enrolled in the optional rider benefit) for any calendar year,
The member must provide itemized bills and an original GHI Explanation of Benefits (EOB) for all charges being submitted.

All claims must be filed within two years of the date of service.
Once you've fulfilled these qualifications, just download the catastrophic claim form (or contact the PBA Funds Office), fill it out, and mail the completed form with the bills and vouchers to:

PBA Funds Office
Catastrophic Benefits Claims
40 Fulton Street, 2nd floor
New York, NY 10038

Police Relief Fund: You should also be aware of the existence of another source of help in catastrophic situations, regardless of your medical carrier — the Police Relief Fund, Inc. This organization provides non-refundable grants to qualified members of the NYPD, both active and retired. Contact the PBA Funds Office for additional information and an application.