In addition to those benefits provided by the City of New York, the Health and Welfare Fund of the Patrolmen's Benevolent Association provides benefits that augment the basic coverage, but vary according to what basic program the member selected. Some supplemental benefits are provided through the purchase of a rider from the various carriers involved and some are provided on a self-insured, self-administered basis.
The Patrolmen's Benevolent Association of the City of New York, Inc. and the Health and Welfare Fund provides an extensive Term Life Insurance program for every active member in the amount of $250,000.
Every Police Officer, when appointed to the force, is required to complete various enrollment cards/forms designating the beneficiary(s) of the life insurance policies. To change the designated beneficiary(s), new cards and/or forms must be completed by the member and filed with the member's records. These enrollment forms may be obtained from the PBA or PBA Funds Office.
Should the member wish to verify the current beneficiary(s) of record, the member must contact the PBA or PBA Funds Office and request the information in writing. The information will be mailed to the member's address of record. Beneficiary(s) information will not be provided via the telephone, or to persons other than the member.
Members are advised that changing the beneficiary designation of the Life Insurance Program in NO WAY affects the New York City Pension beneficiary designation, the Health and Welfare eligible dependent records, or any other program in which the member is enrolled.
The Living Benefit Option allows a covered member with a limited life expectancy to be paid part of the group life benefit, up to a maximum of 50% of the face amount of Insurance, but not to exceed $50,000 (members should consult their tax advisor).
Members are free to spend the proceeds as they wish—on travel, family, expenses, etc. The death benefit payable to the member's beneficiary upon the member's death will be reduced by any benefits paid under the Living Benefit Option. This benefit is available once in the member's lifetime, and is only payable in a lump sum.
Please note that:
If insurance was assigned by the employee previously, this option may not be elected.
The insured must claim this benefit voluntarily. If the insured is required by law or government agency to exercise this option, the claim will be denied.
The consent of the beneficiary is not required when the insured elects the Living Benefit Option.
Life insurance coverage terminates when a member is no longer an active police officer. In most cases a member may apply for a personal policy under the Conversion Privilege within thirty-one (31) days after his or her life insurance ceases. If a person dies during the thirty-one (31) days and before the personal policy goes into effect, the amount payable under the group contract is limited to the maximum amount that could have been converted under a personal policy.
Effective January 1, 1999, a co-payment benefit will be available for all members under which the Health and Welfare Fund of the Patrolmen's Benevolent Association will reimburse the member directly for co-payments incurred by the member and/or his or her eligible dependents for any office visits under the member's City of New York basic health insurance. The Fund will not reimburse the co-payment for diagnostic care (lab and x-rays).
For those members enrolled in the GHI-CBP program, the member is required to submit to the PBA Funds Office a copy of the GHI Explanation of Benefits detailing the fact that an office visit occurred. No other form of documentation will be accepted.
For those members enrolled with HMO and Point of Service subscribers, the member is required to submit a copy of cancelled check(s), both front and back, for each office visit, or a copy of the credit card receipt. To assist in processing your claim promptly, please provide the member's name, member's social security number, patient's name, relationship to the member, and the type of care rendered. No receipts directly from the participating provider shall be accepted.
Each member should submit his or her documentation as it is received. Claims for reimbursement received more than one (1) year after the office visit will be rejected.
The PBA Health and Welfare Fund provides the following benefits on a self-insured and self-administered basis:
For the benefits provided on a self-insured and self-administered basis, the following applies:
Reimbursement of the $25.00 co-payment for hospital emergency room treatment: Under the basic City of New York Empire Blue Cross/Blue Shield program there is a $25.00 co-payment for covered hospital emergency room charges. The PBA Health and Welfare Fund will reimburse the member this co-payment when the member submits the Empire Blue Cross/Blue Shield Explanation of Benefits showing the co-payment and a copy of the itemized hospital statement.
PBA Catastrophic Benefit: This benefit is designed to assist those members who have used non-GHI participating providers and who have incurred, or are reasonably expected to incur, in a calendar year an out-of-pocket expense of $1,250.00 ($1,500.00 if the member is not enrolled in the Hi-Option rider) for GHI covered services for eligible family members. The member must be able to provide itemized bills and original GHI Explanation of Benefits for all charges being submitted. When the member believes his or her out-of-pocket expenses for a calendar year will exceed the catastrophic deductible ($1,250/$1,500), the member should:
Contact the PBA Funds Office and request a Catastrophic Benefit Claim Form.
Complete the catastrophic claim form, including the year for which the claim is being filed, the member's information, the spousal information (if the member is married, the member must complete the spouse's information), the patient information (complete for all patients, including the member and/or spouse since this benefit is per family per calendar year and includes any bills with a balance for all eligible family members).
Sign and date the front of the Claim form.
Sign and Date the Authorization to Release Information located on the back of the claim form.
Attach copies of all itemized provider bills received to date. Itemized bills must contain:
(1) Provider's name and address
(2) Provider's Tax ID number
(3) Date of Service
(4) Type of Service
(5) CPT code for the Service
(6) Provider's Fee for the service with the remaining balance due after the insurance payment
Attach all GHI Explanation of Benefits (EOB).
If the member, patient and /or spouse has other medical coverage, attach copies of the Explanation of Benefits, including rejections, if applicable.
Mail the completed claim form with the bills and vouchers to:
PBA Funds Office
Catastrophic Benefit Claims
125 Broad Street
New York, NY 10004-2400
The PBA Funds Office will review the information submitted and will request any additional documentation needed to process the claim. Payment will be based on a fee schedule set by the Trustees and payment will be sent directly to the member, with a statement showing the service being covered and the balance that is the member's responsibility.
The PBA Health and Welfare Fund, on a self-insured and self-administered basis, provides the following benefit for durable medical equipment
Reimbursement of Charges for Durable Medical Equipment
Where certain conditions may require the use of durable medical equipment, such as wheelchairs, artificial limbs, orthopedic appliances, etc., the PBA Health and Welfare Fund provides a benefit toward the cost of these items. The benefit covers the cost of such durable equipment, but not to exceed eighty percent (80%) of the reasonable and customary charges. There is a maximum of $1,000.00 in a twelve (12) month period and a lifetime maximum of $3,500.00 per family.
To file for the medical equipment benefit you must obtain a Medical Equipment Claim form from the PBA Funds Office. The completed claim form and an itemized bill should be returned to the PBA Funds Office.
The Legal Services Fund of the Patrolmen's Benevolent Association of the City provides job-related legal and civil legal representation to active police officers.
Legal Services Provided
Active members of the Health and Welfare fund are afforded legal services arising out of activities in the scope of their employment as a police officer, subject to the terms and conditions of the PBA's Constitution and By-laws, including:
Also, subject to the terms and conditions of the PBA's Constitution and By-laws, the Fund's attorneys will provide legal defense in certain civil proceedings brought against a covered member in State and Federal Courts. These cases stem from a member having taken police action within the scope of his or her duties or otherwise having acted lawfully as a police officer, when the City of New York fails or otherwise refuses to provide a legal defense.
Provider of Legal Services
Covered legal services are provided as of May 1, 1998, by the firm of:
Worth, Longworth, & London, LLP
111 John Street
New York, NY 10038
Application for Legal Benefits
When the services of any attorney are needed to assist in any of the covered services, the member should telephone his or her PBA board member at the PBA office at (212) 233-5531 or the PBA General Counsel's office at (212) 298-4144.