Overview: Lessons Learned After 9-11-01

Changing Beneficiaries, adding coverage, retirement changes & free coverage

After 9-11-01 there were way too many sad and unfortunate nightmares where certain family members of those we lost thought they had protection, but didn’t. You have a dangerous job. If something unfortunate were to happen to you, the information assembled here will help ensure that coverage (life insurance or other types of insurance) remains in full force for your loved ones. Every firefighter should look this section over from time to time—especially the checklists in the beginning—and update their info any time they have a life change. You are entitled to various types of insurance opportunities during your career. Some of them are automatic, or free. Others are optional at a cost. As time goes on you are sure to go through many life and responsibility changes where it would be advisable to update your coverage or beneficiaries. This chapter/booklet will help you decide which coverage is most advantageous to you and your family, and who to notify if any change is warranted.

Respectfully and fraternally,

Eric DioGuardi

UFA Recording Secretary

Keeping Your Insurance Coverage Current

Change of Beneficiary Checklist:

The UFA, FDNY, and certain insurance carriers do not share member and beneficiary info. It is advisable to review your beneficiaries each time any of the following occur: marriage, divorce, change of domestic partners, or new birth or adoption, loss of a family member, change of eligible dependents, add or remove a person as a life insurance or other beneficiary if you or your spouse die, or to add or remove a person from any health insurance policy.

Time Sensitive: These notifications are often time-sensitive. You may lose benefits if you make a late notification. Be sure to notify each of your insurance providers ASAP to ensure that coverage will remain in full force for the beneficiaries you wish it to. Make sure you do the following, if applicable:

1. FDNY Pension Beneficiary: re your retirement pension contributions return and entitlements upon your death; to change a designated beneficiary, send a notarized ‘Designation of Beneficiary of Death Benefits’ to the FDNY Pension Benefits Unit.
2. NYC Health & Medical Plans: Doctor/medical care & hospitalization; fill out and forward ERB Form (Employee Health Benefit Application) with copies of Birth Certificate and Social Security Card, to add dependent to your medical plan to the FDNY Bureau of Personnel Resources/Health Plan Unit. Must be submitted within 31 days of the event.
3. FDNY Life Insurance Fund: is automatically updated when you notify the FDNY Bureau of Personnel Resources/Health Plan Unit
4. UFA Security Benefits Fund (SBF) Supplemental Health Benefits Coverage: Prescription drugs, dental, optical, anesthesia supplement, hearing aids; Copies, as appropriate, of marriage certificate, birth certificate, adoption decree, court guardianship papers, death certificate, divorce decree, certificate of domestic partnership, or affidavit of domestic partnership termination MUST accompany your notification to SBF Office for each respective matter. Submit these with a letter within 31 days of the event to SBF.
5. UFA Death Benefit: Which is separate from the UFA Group Life Insurance, is automatically updated when you notify the SBF as noted above.
6. UFA Group Life Insurance: Term coverage through the UFA; fill out UFA Group Life Insurance Beneficiary form and send to UFA Group Life Insurance Office.
7. Surgical Assistance Fund: This is automatically updated when you notify the SBF of the change of beneficiary.
8. UFA Catastrophic Major Medical Insurance Plan: a UFA affiliated program; you must directly notify Seabury & Smith /Marsh Affinity (formerly Albert Wohlers & Co.) through the contact info listed on your policy and by sending a letter regarding the change of covered person. Note: This company is especially strict when it comes to notification. If you do not let it know of additions within 30 days of a new birth, then that dependent will be added, BUT the 12-month restriction concerning pre-existing medical conditions only begins when that addition notification is made—and plan coverage will not be retroactive.
9. AFLAC Cancer Plan: a UFA affiliated program; you must directly notify AFLAC in writing through the contact info listed on your policy regarding the change of covered person.
10. AFLAC Personal Accident Expense Plan: a UFA affiliated program; you must directly notify AFLAC in writing through the contact info listed on your policy regarding the change of covered person.
11. Deferred Compensation: a NYC payroll deduction investment plan; to change the beneficiary, fill out and forward Enrollment/Change Form to Deferred Compensation.
12. Compensation Accrual Fund (Annuity): your automatic annuity investment plan; notify the SBF in writing of a change of beneficiary.
13. Fraternal Organizations or Societies Life Insurance: to change beneficiaries, notify the respective organization for instructions.

Change of Address Checklist:

The UFA, FDNY, and certain insurance carriers do not share member info. If you change your address or phone number, be sure to notify each of your insurance providers. This will ensure that your coverage will remain in full force and that you will continue to receive any timely notifications, invoices, and new info. Make sure you do the following, if applicable:

1. NYC Health & Medical Plans: Doctor/medical care & hospitalization; prepare and submit Change of Address Forms with the FDNY through your Officer.
2. FDNY Life Insurance Fund: This is automatically updated when you notify the FDNY.
3. UFA Security Benefits Fund (SBF) Supplemental Health Benefits Coverage: Prescription drugs, dental, optical, anesthesia supplement, hearing aids; prepare an SBF Change of Address Form and submit to SBF.
4. UFA Death Benefit: is separate from the UFA Group Life Insurance, and is automatically updated when you notify the UFA SBF of change of address.
5. UFA Group Life Insurance: Term coverage through the UFA; contact the UFA Life Insurance Office.
6. Surgical Assistance Fund: This is automatically updated when you notify the UFA SBF of a change of address.
7. UFA Catastrophic Major Medical Insurance Plan: a UFA affiliated program; you must directly notify Seabury & Smith /Marsh Affinity (formerly Albert Wohlers & Co.) through the contact info listed on your policy.
8. AFLAC Cancer Plan: a UFA affiliated program; you must directly notify AFLAC through the contact info listed on your policy.
9. AFLAC Personal Accident Expense Plan: a UFA affiliated program; you must directly notify AFLAC through the contact info listed on your policy.

Domestic Partner Coverage & Insurance Coverage:

Not all insurance coverage applies to domestic partners. It is advisable to check with your individual carrier to verify coverage, regardless of what is noted here, as policies may change. Use this as a guideline before contacting your particular carrier:

1. Covered—Domestic Partner coverage may apply:
   • NYC Health & Medical Plans: See NYC Health Plans Section for info
   • UFA Security Benefits Fund (SBF) Supplemental Health Benefits Fund: See SBF Fund Section for info
   • Marsh Affinity Catastrophic Insurance: (formerly Albert Wohlers & Co.) The same process required for NYC Plan approval is required for inclusion. If NYC approval is granted, you can apply via a special application form which must be sent to you by Marsh Affinity Catastrophic Insurance.
2. Not Covered—Domestic Partner coverage does not apply:
   • UFA Group Life Insurance Plan: there is NO coverage for domestic partners through the AIG life insurance company.
3. Not Researched: Not all domestic partner coverage has been verified at the time of publishing. Check with each company to determine if domestic partners are covered.

COBRA Benefits—Continuation of Benefits upon Separation:

The Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires that the City offer employees, retirees, and their families the opportunity to continue group health and/or welfare fund coverage in certain instances where the coverage would otherwise terminate. If you or a member of your family are terminated, and are not covered under the Retiree’s Program, you may continue your basic health coverage through COBRA, for a cost. You must enroll with your health carrier within 60 days of termination. See Health Book (NYC Health Plans Chapter: COBRA section, and also Security Benefits Fund Chapter: Suspension/Termination section) for more info.

Life Insurances

SBF Death Benefit

The Security Benefit Fund Death Benefit, available at no cost, is payable, in accordance with the below schedule, upon the member’s death from any cause at any time while eligible. Payment is made in a lump sum to the beneficiary designated by the Firefighter on the Security Benefit Fund enrollment card, provided this beneficiary is living at the time of the Firefighter’s death. If the beneficiary is not living on the first anniversary of the Firefighter’s death, payment is made to an alternate beneficiary. If the alternate beneficiary is not living, the death is payable to the Firefighter’s estate. Changes of beneficiary or alternate beneficiary may be made at any time by the Firefighter by contacting the SBF Office at (212) 683-4723. The SBF office will mail a claim form to the Firefighter’s beneficiary in case of his/her death. Payment is made to the beneficiary upon submission of a completed claim form with a certified death certificate.

a. Active, all ages:	$10,000
b. Retired, up to age 49:	$10,000
c. Retired, age 50 to 69:	$5,000
d. Retired, 70 and over:	$2,500

Notifications for Benefits: Both the FDNY and the UFA initiate paperwork to process retiree death benefits once it has been published on an official Department Order. To notify Fire Department Headquarters of a firefighter’s death, please phone Death Notifications & SBF.

NYC Fire Dept. Life Insurance Fund

This insurance is mandatory—you don’t have a choice. It is automatically deducted from your paycheck. This is far from being a cost-effective policy for active members, but we must bear the weight for offsetting the cost/coverage for our retired members and their families. This policy doesn’t end at any age limit, and it covers retirees of every category. The amount of retirees continues to steadily outgrow the number of active UFA/UFOA members, causing a greater negative experience impact upon retiree costs. This FDNY mandatory death benefit is guarantee pay out to every member’s beneficiary, including yours, as you too will be retired some day and be seeking similar assistance from the then active membership. Beneficiary changes should be made with the FDNY Pension Office by calling (718) 999-2321.

1. Current July 1, 2007:
   1. The death benefit for active participants is $8,500.
   2. The monthly life insurance premium is $9.00 ($4.15 per biweekly pay period for active participants).
   3. The retiree death benefit is $6,000 (effective 7/1/07).
2. History & Importance of the Fund: The latest increases took effect between 1998 and 2001. The $3.00 per month premium had not changed since 1945. The Trustees believe that this Fund, which has been in existence since 1870, provides an important level of death benefits. It was created because many firefighter and officer families at that time could not afford funeral or burial costs. Today, any cuts in benefits would especially hurt older participants who have contributed to this Fund over a lifetime.

Therefore, the Trustees had New York State legislation enacted to allow an increase in the premium to what it is today. The Board of Trustees is legally bound by the decisions of the Chief Actuary relative to the level of benefits that may be supported by any given premium rate. The Board of Trustees has also been advised by the New York State Department of Insurance that it should act upon the Chief Actuary’s recommendations.

Consequently, the Trustees, along with the Chief Actuary, given a choice between reduced benefits or increased premiums, believe that the revisions to the premiums and benefits described herein represent the best choice for the Fund and its participants.

NY Fire Dept. Welfare Fund

All companies automatically receive the below benefit, at no cost, from the Welfare Fund (which also has other FF benefits besides death assistance) for the death of any active member assigned to their company. See New York Fire Dept. Welfare Fund subsection for more non-life insurance info about the Welfare Fund, which is later in this chapter.

• $500: LODD Plaque Dedications
• $7500: LODD Funeral Collations
• $2000: Non-LOD Funeral Collations

AFLAC NY Personal Accident Policy

Members who carry this optional insurance also receive a death benefit of $25,000 for accidental death. See AFLAC NY Personal Accident Expense Plan section for more non-life insurance info about this insurance plan, which is later in this chapter.

UFA Group Life Insurance Program

The Uniformed Firefighters Voluntary Group Life Insurance Program was started in 1978 and has been a tremendous success. This program is an important benefit available to all of our members. Listed below is a breakdown of the payroll deductions. One of the most attractive features of this program is the convenience of having your premium deducted along with your dues in your bi-weekly paycheck. The breakdown below will make it easier for the delegate to answer any questions a member may have relative to his or her insurance coverage based on their payroll deduction. For group life insurance changes (e.g., policy amount, dependent coverage, change of beneficiaries) call the U.F.A. office (212) 683-4723 (ext 5903) and ask for Maria Zingone.

1. Policy Documents From Insurer (see following pages)
2. Active: Mandatory Bi-Weekly Union Dues $27.10 + $2.00 (Funeral/Scholarship) = $29.10 UFA Group Life Insurance Payroll Deductions for Firefighters and Fire Marshals

Effective January 1, 2015

Anyone electing the UFA Group Life Insurance Plan automatically is provided with an Accidental Death and Dismemberment Plan, coverage follows:

• Active Member $100,000
• Spouse/Child(ren) $25,000/$5,000
  1. Retired:

UFA Group Life Insurance Rates for Retired Firefighters / Fire Marshals as of 3/99

1. General Terms & Conditions
   1. Subsidized: The UFA offsets EVERY retiree premium in the Group Life Insurance program. See UFA Subsidy column
   2. Dues: To keep policy, you must be a dues-paying member in good standing ($18.00 per year for retirees). Even the lowest possible policy coverage more than makes up for the annual dues.
   3. Coverage Limits: The life insurance benefit amount available to be carried into retirement will be based upon the amount of active insurance you had in effect one year prior to the retirement date. Must have had upgrade approval before the one-year cut-off date. Later upgrades will not be calculated into the retirement formula.
   4. Retired: A member who retires is permitted to maintain a portion of the insurance he/she had while an active UFA member. For example: If an active firefighter has the $100,000 coverage when retiring he may remain enrolled in our insurance program with a maximum of $ 50,000. All dependent coverage you presently have will be set a $25,000/$4,000. The exception is a member who had $25,000 reduced to

$12,500 – at no point is a spouse permitted to have more insurance than a member.

1. Effective March 1999, the UFA will no longer offset premiums of new promotees above the rank of Firefighter/Fire Marshal/Wiper. The total premium must be paid by members promoted after 3/1/99 who wish to maintain the UFA Group Life Insurance Policy. Effective January 1, 2007, the UFA will no longer subsidize any promoted premiums prior to March 1, 1999.
2. Ages 65 – 70 reductions: Between the age of 65 and 70, the amount of this policy coverage will drop 20% on each birthday. At age 70, coverage ceases.
3. Whole Life Conversion: For information concerning the possible conversion of all or part of your insurance to a whole life policy please call the UFA office. The UFA provides you with a conversion note, but has no part in the required rate charged. This deal is between the member and the insurance broker.

Primary Health / Medical Coverage & Optional Riders

Medical Misconduct

If you feel that any doctor treating you or your dependents has not practiced honestly or competently, you should file a complaint with the N.Y. State Dept. of Health, which investigates all professional misconduct by physicians or physician assistants. All reports are kept confidential. The investigation may result in a hearing before a committee of the Board for Professional Misconduct. There must be sufficient evidence of a possible violation before a hearing is held. The Board consists of physicians and consumer members, which will acknowledge receipt of your complaint, provide specific information regarding the investigation, and will inform you of the final determination. See Health Book (NYC Health Plans chapter: Medical Misconduct) for more info and how to file a complaint. If the doctor at issue is an FDNY BHS Medical Officer or a doctor assigned/referred by the BHS, also refer to the FDNY Book (BHS Chapter: Difficulties with Medical Office Personnel) for instructions.

NYC Health Benefits Program (Major Medical Insurance)

This program covers all employees of the FDNY for major medical / doctor costs and hospitalization. Members are entitled to select from various plans offered (from different providers) by the City. There is no cost for basic coverage under some of the health plans offered under the City Health Benefits Program, but others require a payroll or pension deduction. Enrollees may purchase additional benefits through Optional Riders for all plans. See NYC Health Plans Book for more info.

Health Benefits Buy-Out Waiver Program

The Health Benefits Buy-Out Waiver Program entitles all eligible employees to a cash incentive for waiving their City health benefits so long as they have another source of coverage (e.g.; a spouse’s plan, another employer or Medicare). Annual cash payments are made to the member, which are taxable income. If your spouse is employed by the City, you are not eligible for the Buy-out. See NYC Health Plans Book for more info.

Health Care Flexible Spending Account (HCFSA)

The Health Care Flexible Spending Account Program is designed to help participants pay for necessary medical expenses not covered by insurance. This is helpful if you anticipate large or recurring annual medical expenses. A Flexible Spending Account is funded through pre-tax payroll deductions, effectively reducing the participant’s taxable income. Participants submit claims for Eligible Medical Expenses to the plan office and receive a reimbursement check — not subject to federal income tax or social security tax (FICA) — from the Flexible Spending Account. The amount of tax savings depends on the participant’s income tax bracket and the amount contributed to the Flexible Spending Account. See Health Book (NYC Health Plans chapter) for more info.

1. UFA Security Benefits Fund (SBF) (Supplemental health coverage)

(Dental, Prescription Drugs, Optical, & More)

The SBF covers your family /dependents for various supplemental health benefits, including dental, anesthesia, optical, hearing aid, and prescription drugs. All benefits provided by the Security Benefit Fund are funded through employer contributions and are managed by the UFA. No contribution is required on the part of the Firefighter. SBF coverage is totally independent (and different) from your NYC Health Plan coverage (GHI, HIP, Blue Cross/Blue Shield, etc.).

Medicare: City Coverage for Retirees

Medicare is your first level of health benefits. When you or one of your dependents becomes eligible for Medicare at age 65 (and thereafter) or through special provisions of the Social Security Act for the Disabled, your first level of health benefits is provided by Medicare. The Health Benefits Program provides a second level of benefits intended to fill certain gaps in Medicare coverage.

In order to maintain maximum health benefits, it is essential that you join Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) at your local Social Security Office as soon as you are eligible. If you do not join Medicare, you will lose whatever benefits Medicare would have provided. The City’s Health Benefits Program

supplements Medicare but does not duplicate benefits available under Medicare. Medicare eligibles must be enrolled in Medicare Parts A and B in order to be covered by a Medicare HMO plan. See Health Book (NYC Health Plans chapter: Medicare) for more info.

Catastrophic Major Medical Insurance

1. Overview: This plan will help protect your life savings, or even your home, should some medical tragedy strike you or your family. All members, especially those not in an HMO, are advised to supplement their basic health coverage’s by enrolling with Catastrophic Insurance. Some accidents or major illnesses can leave you injured and may require extensive surgery, long-term hospitalization and perhaps home health care before you are fully recovered. If your health care bills go beyond your medical plan’s cap, then you have to pay. A major illness or accident can easily deplete the benefits of a basic medical insurance plan. The Catastrophe Major Medical Plan pays when your basic health insurance plan has reached its limit, including Medicare. This plan is available to UFA members through the Insurance Administrator, Marsh Affinity Group Services (formerly Albert H. Wohlers & Co.). You can also download brochures or applications.
2. Benefit Features:
   1. Helps pay up to 100 percent of all eligible expenses
   2. Deductible can be satisfied with expenses paid by basic health insurance or out-of-pocket
   3. Convalescent care and home health care coverage
   4. Family coverage available
3. Making a Claim with your Primary Health Insurance: There have been numerous complaints about basic NYC Health Plans denying payment of medical bills when a member tells the NYC health carrier that he/she carries other insurance. You can prevent this scenario from taking place. Technically, Catastrophic coverage is NOT a health insurance carrier by legal definition, and it need not be listed when your basic health plan (or hospital form) asks if you have any other insurance. DO NOT MENTION your Catastrophic Coverage to anyone else other than the Catastrophic carrier itself. The basic NYC health carrier is confusing this supplemental protection policy with duplicate primary coverage, which is not the case. Based on that (incorrect) assumption, they are denying member coverage for allowable procedures. This all leads to long delays, needless letters and many frustrating phone calls. Simply put—your Catastrophic is not medical insurance.
4. Rate Chart, Eligibility, Application from Insurer

See following pages for insurance company documents and plan descriptions. Payout amounts and policy rates may vary over time. Always contact the Catastrophic Insurance Carrier for current rate charts and coverage limits before considering enrollment.

AFLAC Personal Accident Expense Plan

Overview: Getting hurt on our job is a fact of life, especially while on duty, and it is your right to request to be taken by ambulance to the hospital or be seen by a doctor for treatment. The money paid to you is substantial and if it is a serious injury requiring a lengthy hospital stay; it could amount to thousands of dollars to cover bills while you are healing. This is a great thing for us and our families and we urge all of you to participate. Don’t wait until you get hurt and need it but can’t get it.

1. Accident/Disability Coverage: The AFLAC Accident Plan is designed to help cover the expenses associated with an accidental injury. It pays you directly, unless you assign benefits, regardless of any other insurance you may have. Benefits include: accident hospital confinement, accidental death and dismemberment and many others—including Line-of-Duty Injuries. It has many benefits, and some limitations. There are no medical questions to answer, and no money needed to join. Make sure you review ALFAC Plan literature in this chapter for details. If you or a covered family member has an accident, AFLAC N.Y. will pay you tax-free cash in the following circumstances:
   1. ambulance ride to the hospital, $120;
   2. emergency room treatment by a physician, $75;
   3. initial overnight hospital stay, $1,000;
   4. each additional day spent in the hospital, $200;
   5. intensive care confinement benefit, $400 a day (up to 15 days per covered accident);
   6. accidental death/dismemberment, $25,000;
   7. and accident follow-up treatment, $50 per treatment day, up to six visits, which is payable in addition to the physical therapy benefit.
   8. Cash benefits are paid to you directly, if you are getting physical therapy treatment, receiving blood or plasma, or are in need of a prosthetic device (artificial leg, etc.) or appliances such as crutches, wheelchairs, leg or back braces and walkers.
   9. Family Lodging: substantial cash benefits are paid for family lodging and transportation needs.
2. Payroll Deduction: This new plan is available through payroll deduction from AFLAC N.Y., our long-time cancer provider, for affordable rates.
   1. Individuals pay $9.79 per pay period or 70 cents a day;
   2. individual and spouse, $11.22 per pay period or 80 cents a day;
   3. one-parent family, $12.60 per pay period, 90 cents a day; and
   4. two-parent family, $14.77 per pay period, $1.05 per day.
3. How do I Join or Make a Claim? Contact AFLAC New York. See Forms Section for applications.
4. Rate Chart, Eligibility, Application from Insurer

See following pages for insurance company documents and plan descriptions. Pay-out amounts and policy rates may vary over time. Always contact AFLAC for current rate charts and coverage limits before considering enrollment.

AFLAC NY Personal Cancer Plan

1. Overview: When a covered individual is diagnosed with cancer, this plan provides benefits for hospital confinement, radiation and chemotherapy, and surgery, among others. In addition, AFLAC will pay a First Occurrence Benefit when a covered individual is first diagnosed as having internal cancer. AFLAC’s plan covers you for your entire lifetime. It never expires, as long as premiums are paid when due. Remember, this is not another health insurance plan. It doesn’t pay your medical bills—it pays directly to you. AFLAC pays you as soon as you or a covered family member gets cancer. From that point on, cash benefits are paid for most treatments received during your struggle to get well. Other benefits are outlined in AFLAC’s brochure. Premiums are paid through payroll deductions for $0.46/day. You can keep the plan after you retire.
2. Wellcare $$ Payments to You: AFLAC pays a special benefit once a year to any member who gets a cancer screening test. The benefit also applies to all spouses and covered children who get a cancer screening from their doctor. In addition to being a smart thing to do, it can make an already inexpensive plan even more affordable.
3. NYC Firefighters & Cancer: UFA interest in cancer insurance is an outgrowth of research commissioned by the UFA, which produced the Cancer Bill, research that documented the higher-than-average incidence of cancer among our active and retired members. Due to the fact that our health plans cover virtually all medical costs associated with cancer, we sought a different insurance product that would help alleviate some of the other financial burdens that can weigh on a family when someone is diagnosed with cancer. Under the AFLAC program, cash payments are rendered for those covered, in the event they develop an internal cancer. This program, AFLAC New York’s Personal Lifestyle Protector Cancer Plan,” was only recently approved for sale in the state of New York, and we are pleased to have tailored a product that we feel offers significant coverage for our members.
4. About AFLAC: AFLAC is a triple-A rated company that has specialized in cancer insurance in the U.S. and abroad for over 40 years, and has demonstrated their commitment to our union with very generous donations exceeding $250,000 to our Widows’ and Children’s Fund.
5. Why is AFLAC Good for You? How often have we all contributed to firehouse fundraisers for one of our stricken brothers or sisters? Many members have had to spend their life savings to pay for all of the non- medical costs of fighting cancer. When you are fighting cancer and can’t work, how do you replace the money you are losing from being able to work overtime or your second job? If you are like most of us, you are totally dependent upon the extra income to maintain the standard of living that you now have. What about the money that is lost when a working spouse gets cancer? How will you pay the extra costs of childcare help, travel, food and lodging along with all of the regular monthly bills (mortgage, rent, phone, car payments, tuition etc.) without their income? AFLAC’s plan can help ease these financial burdens for you.
6. How do I Join or Make a Claim? Contact AFLAC New York. See Forms Section for applications.
7. Rate Chart, Eligibility, Application from Insurer

See following pages for insurance company documents and plan descriptions. Payout amounts and policy rates may vary over time. Always contact AFLAC for current rate charts and coverage limits before considering enrollment.

UFA/UFOA Surgical Assistance Fund

1. History: The Surgical Assistance Fund “SAF” of the New York City Fire Department (DO 111/1992, Supl. 152 & Regs Ch 32/1997) was formally organized on July 1, 1947, being jointly sponsored by the Uniformed Firefighters’ Association “UFA” and the Uniformed Fire Officers’ Association “UFOA.” On October 27, 1992, the assets and liabilities of the New York City Fire Department Surgical Assistance Fund were transferred to the UFA/UFOA Surgical Fund, under the sponsorship of the Uniformed Firefighters’ Association, the Uniformed Fire Officers’ Association, and the Marine Engineers Benevolent Association “MEBA”.
2. Fees: The SAF provides cash partial indemnities from $10.00 to $650.00 per member per year, according to an established fee schedule to its members for surgical procedures only, and certain specified additional items. These benefits are provided at a cost of $15.00 annually for Family Group membership and $10.00 annually for Single Group membership. The SAF Fee Schedule is basic. The allowed amounts are determined by dues collected, consistent with sound operation, and comparable with established national surgical fee schedules. Details of these fee rates are contained in the master fee schedule on file at the SAF. These rates are not the same as, nor should they be confused with the fee rates contained in the Medical Surgical Specialist Plan. As experience develops, and conditions warrant, the SAF will be extended to provide enlargement of benefits and services to the Membership.
3. Eligibility:
   1. Active: The benefits of this fund are open to all active members of the Uniformed Force. Benefit will be provided in accordance with established rules only to the member, his wife, and unmarried children less than 19 years of age. Probationary members may join the Fund at the next annual dues period after their date of appointment.
   2. Retired: Retired members who are in good standing in the SAF, may continue membership in the Fund at their option. The UFA will assume the payment of post-retirement dues for its members and will provide continuing life coverage in the Fund, provided the retiree was a member of the Fund in good standing for at least two years before retirement.
   3. Dependents: Widows and orphan children under 19 years of age of active or retired members of the department, who have been a member in good standing in the SAF, may continue, at their option the deceased’s membership by compliance with the same regulations governing procedures of retired members.
4. Forms & Info: Questions can be answersanswered and forms will be provided by calling the Surgical Assistance Fund. You can leave a voice mail message 24/7 as well.
5. Termination: The responsibility for payment of dues shall be incumbent upon the individuals concerned. Members in arrears are out of benefit and shall be automatically dropped from the SAF rolls. Failure to comply with the rules governing payment of yearly dues will automatically terminate membership in the SAF. Retired members who terminate their membership in the SAF will not be reinstated under any circumstances.
6. By-Laws: The following excerpts from the SAF Rules are for your information and guidance:

SCOPE

Article 1:

• Section 1. ONLY the member, spouse and unmarried children under 19 years of age are entitled to receive Surgical Assistance Benefits from the Fund.
• Section 2. Children 19 years of age and over and the dependents of members in the Single Group Membership, are not entitled to Benefits in the Surgical Assistance Fund (includes full-time students).
• Section 3. Procedures specified as coming within the scope of the Surgical Assistance Fund may be performed in either a hospital or a doctor’s office.
• Section 4. The choice of the doctor rests entirely with the member. In each case, the member’s claim will be adjusted with the amount allowed for surgery or other specified procedure performed, as established in the Surgical Assistance Fund scheduled fees (Article X).
• Section 5. The amount allowable for procedures shall not exceed the fees established in Article X.
• Section 6. When the fee charged to a member by a doctor is less than the fee established in Article X, the Schedule of Fees, then, the fee charged to the member by the doctor shall be accepted as the basic fee rate to the nearest multiple of five dollars but not in excess of the doctor’s fee.
• Section 7. All claims will be adjusted in accordance with the amounts allowed in Article X for specified procedures performed, or when not so established then as determined by the Medical Director of the Surgical Assistance Fund.
• Section 8. Membership in any other health plan will not bar membership in the Surgical Assistance Fund and ALL MEMBERS of the Surgical Assistance Fund are entitled to receive all benefits thereof.
• Section 9. If the surgical procedure was paid for or was covered by F.D.N.Y. Compensation, the Surgical Assistance Fund will NOT pay any claims submitted by members for surgery resulting from injury or illness caused or induced in the line of duty.
• Section 10. The Surgical Assistance Fund will NOT pay any claims resulting from procedures rendered by or obtained through the provisions of US. Public Health Service Laws; Workers’ Compensation Laws; a medical department maintained by a member’s employer; or performed as the result of gratuitous or charitable services in which the member contributed neither surgical payment nor surgical premium.
• Section 11. Excluded from the Surgical Assistance Fund are all claims for the following: X- Rays; consultations; examinations; diagnoses; office visits and hospital visits: operating room and equipment; Electro coagulation and Catheterization procedures, except as otherwise provided for; dilatation, probing and irrigation procedures; Electrocardiographs; Treatment of allergies; Non- surgical care of Pulmonary tuberculosis; Cosmetic Surgery; Immunization or other prophylaxes; Drugs, dressings or medicines; Radiology: Pathology; Physiatrist: Functional disorders of the mind or nervous system; Shock treatments; Anesthesiology; Non- surgical care of communicable diseases: Outpatient services; Physiotherapy; Rest cures, Nursing services; Services of physicians when their fees for your care are claimed by hospitals, laboratories or other institutions: Non-surgical treatment for Poliomyelitis; Blood, blood plasma, and blood analysis; Orthopedic, surgical and/or physiotherapeutic appliances and equipment; Injections, punctures, infusions, transfusions, hypodermoclysis and intravenous procedures; Ambulance service.

BENEFITS

Article V:

• Section 1. Claims must be for SURGERY only, with the following exceptions:
  • Reduction, immobilization and/or casting of fractures and/or dislocations;
  • Medically accepted instrumentations, either diagnostic or therapeutic, except as otherwise provided for;
  • Application of plaster casts (independent procedures only);
  • Radiation & Cobalt treatments, when administered in CANCER cases only (Out- Patient).
• Section 2. Only CEASARIAN SECTION claims will be honored in Maternity Cases.
• Section 3. Dental work of all kinds is excluded and will not be paid for by the Surgical Assistance Fund.

PROCEDURE FOR OBTAINING BENEFITS

Article VI

In making an application for benefit in the Surgical Assistant Fund the Member shall file MD-35 form in duplicate. This application shall be accompanied by EITHER of the following:

1. An authorized signed statement of operation, on Fire Department MD48 form or on Hospital stationary, giving required information; or
2. A statement of operation from the Doctor, on HIS/HER stationery, giving the name of the Patient, Diagnosis, Full nature of operational procedure, Date performed, and signed by a Doctor.
3. Section 5. Complete applications for benefit (MD-35 & Statement of Operation) shall be submitted for processing within six months following the date of the surgical procedure performed.
4. Section 7. Applications submitted one year or later from the date of the procedure performed will NOT be considered under any circumstances.
5. Section 7a. Sections 5, 7, & 7a of Article VI shall be applicable to applications muted to members for any and all information necessary and required for the processing of applications in accordance with rules governing the Surgical Assistance Fund.

PROCEDURES FOR RETIRED MEMBERS AND WIDOWS / WIDOWERS

Articles VII & VIII

• Section 3. Payment of dues shall be made to the order of the Surgical Assistance Fund by check or money order. Your canceled check or money order stub will be your receipt.
• Section 4. Change of status from Single Group to Family Group, or vice versa, shall be made only at the time of payment of yearly dues.
• Section 5. Notification of change of address shall be the responsibility of the member concerned.
• Section 6. Payment of yearly dues at the time specified shall be the responsibility of the member concerned.
• Section 7. FAILURE TO COMPLY WITH RULES GOVERNING PAYMENT OF YEARLY DUES WILL AUTOMATICALLY TERMINATE MEMBERSHIP IN THE SURGICAL ASSISTANCE FUND.
• Section 8. MEMBERS WHO TERMINATE THEIR MEMBERSHIP IN THE SURGICAL ASSISTANCE FUND WILL NOT BE REINSTATED (AS RETIRED MEMBERS OR AS WIDOW/WIDOWER MEMBERS) UNDER ANY CIRCUMSTANCES.
• SURGICAL ASSISTANT FUND

Health/Medical Help – Free

Surgical Assistance Fund

This additional coverage is free for Retirees who were paying active members of the UFA/UFOA Surgical Fund for two years immediately prior to retirement. See Surgical Assistance Fund earlier in this Chapter for additional info about this fund.

Honor Emergency Fund, Insurance

The Honor Emergency Fund (FDNY Regs. Ch 32) is a not-for-profit foundation serving the Fire Department since 1921. Since that time, it has helped thousands of Department employees, uniformed and civilian, active and retired with the burden of costs, after any insurance, with most forms of medical care as well as other related areas. The Fund exists “for the welfare and relief from want or distress arising from death, illness or injury” of members of the Fire Department and their statutory dependents including spouse, children, and occasionally parents.

• Coverage: Specifically these are the areas in which the Fund can provide assistance:
  1. Medical procedures such as surgery, physician care, anesthesia, in and outpatient services, lab tests, etc.
  2. Home health care services if medically necessary and physician authorized.
  3. The Fund gives monthly stipends ranging from $100.00 to $500.00 to qualified older adults or disabled individuals to assist them in meeting a serious and ongoing financial shortfall or to enhance the overall quality of life due to financial constraints.
  4. Speech, physical, and occupational therapy.
  5. Specialized life-maintaining or enhancing equipment.
  6. Medically necessary dietary supplements.
  7. Grants for psychotherapy or psychiatric services.
  8. Prescribed therapeutic devices.
  9. Non-routine maternity care including extra-special medically- necessary procedures, non-routine cesarean deliveries, and specialized in-hospital non-routine new-born baby care.
  10. Dental expenses, but only if due to a medical problem.

If an applicant is forced to pay for necessary or emergency medical care in advance of service without which such service or care would not be rendered, the Fund Trustees consider reimbursement for such money already expended if that entailed a financial hardship.

• Who are the Trustees of the Fund? All Trustees donate their services and time and do not receive any form of remuneration.
  1. The Fire Commissioner serves as the Fund Chairman
  2. The Chief of Department
  3. One Deputy Chief*
  4. One Battalion Chief*
  5. One Captain*
  6. One Lieutenant*
  7. One Marine Engineer*
  8. One Firefighter*,
  9. Civilian Trustees (no predetermined #), by statute the civilian Trustees must be chosen from among the ranks of active honorary Fire Department officers. They have a long and abiding interest in and concern for the Department and its members. They bring to the Board their expertise in business, investment and medicine as well as a sensitivity to the needs of this Fund.

*appointed by the Fire Commissioner, and after ratification serve at his pleasure.

• How does the fund work?
  • Residual medical bills: The Trustees may make grants to cover all or part of the balances owed on medical bills due after all available health insurance benefits have been applied or it has been established that a particular medical service was not covered by a health plan. The Medical Director of the Fund actively participates in the work of the Fund and is available to advise the other Trustees as to whether the fees charged are reasonable and consistent with prevailing rates. The Fund also provides grants for home health care assistance. These care workers do personal care, home chores, and minor nursing services to individuals unable to care for themselves or where the spouse or other family are overwhelmed by the responsibility. Grants go up to $5,000 for a 12-month period. Requests for extensions are considered.
  • Psychiatric and psychological assistance: The Board currently approves psychotherapy up to

$1,000.00 a year for outpatient therapy and/or psychiatrist services and $2,500.00 a year towards any residual expenses due to in-patient care. There is a cap of $7,500.00 on in-and-out-patient psychological assistance grant disbursements per family in any 12-month period in the event that continued financial and psychological problems persist and the grant(s) runs its course, the Trustees on a case-by-case basis may approve an additional grant within the same 12-month period. Grants are also considered upon re-application.

• Emergency Grants: an Executive Emergency Committee exists to review cases where prompt payment is required for medically related admission and treatment or for relief from short-term acute financial stress arising from illness. Up to $5,000.00 per applicant or family may be expended with no more than
  • $15,000.00 approved for payment by the Committee between regularly scheduled meetings of the full Board.
• Exclusions: Note that a number of medical areas are excluded from H.E.F. grant consideration. These include dental expenses not related to a larger medical problem, cosmetic surgery, and routine maternity and well-baby care.
• Eligibility Criteria: The Trustees consider the nature and extent of the problem and the applicants overall financial and personal picture. Financial need, while a prime criterion for assistance, is looked at in terms of this entire personal or family situation. All information is held in strict confidence.
• Confidentiality: In all situations where financial help is sought from the Fund, information regarding income, expenses, savings and resources, tax returns, and any pertinent related information is confidentially reviewed by our Board of Trustees.

Welfare Fund of the New York Fire Department

1. Overview: The Welfare Fund (FDNY Regs. Ch 32) is an excellent source to cover expenses of various necessities encountered by injured or LODD members as well as certain company expenses. Summaries are listed below, with complete bylaws immediately following:
   • $300 Destroyed commissary items
   • $500 LODD Plaque Dedications
   • $7500 LOD Funeral Collations
   • $2000 Non-LOD Funeral Collations
   • $300 Permanent move of a Company to another Company location (for commissary & kitchen supplies)
   • $600 Setting up a new Company (for commissary & kitchen supplies)
   • $20,000 limit for charitable contributions
   • $5/day LODI hospitalized member phone costs
   • $Varies LODI hospitalized member reasonable TV costs
   • $150 Ambulance service (after Health Plan reimbursement attempt exhausted)
   • $Varies Medical equipment & services for member
2. By-laws: The following SAF Rules are reproduced for your information and guidance:
   • Section I – The office of the Welfare Fund shall be located in the City and State of New York, County of Kings, at 9 Metro Tech Center Brooklyn.

1. MEETING PLACE OF MEMBERS
   • Section II – The meeting of members shall be held at 9 Metro Tech Center, Brooklyn, State of New York, the office of the Fund, or at any other location as agreed to by a majority of the members of the Board.
   • Section III – Meeting – A meeting of members shall be held monthly excluding the month of August to transact Fund Business, except special meetings which may be called by at least three members of the board, with at least 72 hours’ notice to all members.
2. CONTRIBUTIONS
   • Section IV – The Welfare Fund is mainly supported by payment on behalf of firefighters through the Security Benefit Fund, and payments from fire officers, licensed pilots, and engineers, by individual fixed payments.
3. BENEFITS
   • Section V – Benefits shall only cover active members of the Fire Department.
   • Section VI – There shall be a limit of $300.00 per location for the replacement of destroyed commissary items, except where there are extenuating circumstances. The Board will, in these cases, decide on the amount of reimbursement.
   • Section VII – The Welfare Fund shall pay out up to $500.00 for plaque dedication expenses, except when more than one member of a unit dies in the line of duty, then the Board will decide the amount allowed. Each of the excepted incidents will be treated separately.
   • Section VIII – The Welfare Fund, upon application, shall disburse up to $7,500.00 to a fire company which serves a. collation to members following a line of duty funeral, except where more than one member of the same unit dies in the line of duty, then the Board will decide the amount allowed.
   • Section VIII (A) – The Welfare Fund, upon application, shall disburse up to $2,000.00 to a fire company which serves a collation to members following the funeral of an active member where death occurred from non-line of duty causes. Where more than one member from the same unit dies from non-line of duty causes the Board will decide the amount allowed.
   • Section IX – The Welfare Fund, upon application, shall disburse up to $300.00 to defray the cost of a Company moving from one Company to another Company where the move is a permanent one. This disbursement shall be used for commissary and kitchen supplies.
   • Section IX (A) – The Welfare Fund, upon application, shall disburse up to $600.00 to defray the cost of setting up a newly-established, Company. This disbursement shall be used for commissary and kitchen supplies.
   • Section X – Any contributions by the Welfare Fund to various charitable organizations shall be decided by the three (3) chairmen of the employees’ organizations and shall be limited to $20,000.00 per year. These contributions are to be distributed once each calendar year, by the Fire Commissioner and Presidents of the three line organizations; U.F.A., U.F.O.A., M.E.B.A., or their designated representatives.
   • Section XI – The Welfare Fund will reimburse members injured in the line of duty for reasonable television set rentals, and a maximum of $5.00 per day for the use of telephone facilities in hospitals. For long-term cases, these expenses may be billed directly to the fund for prompt payment.
   • Section XII – After determining that the Welfare Ambulance is not available, and after all attempts at reimbursement by Health Plans have been exhausted, the Welfare Fund will reimburse members for private ambulance service expenses up to $150.00 for each ambulance usage.
   • Section XIII – Reimbursements to members will be provided by the Welfare Fund for medical equipment and other services based upon application and approval of the Welfare Fund Committee.

•  

1. One person holding a rank above Captain, to be designated by the President of the UFOA.
2. One person holding the rank of Captain, to be designated by the President of the UFOA.
3. One person holding the rank of Lieutenant, to be designated by the President of the UFOA.
4. Three persons holding the rank of Firefighters, and designated by the President of the UFA.
5. One person holding the rank of Pilot or Marine Engineer, and designated by the Marine Engineers’ Benevolent Association.
6. Fire Commissioner, or representative designated by the Fire Commissioner – Chairman.
7. Chief of Department or representative.
8. Personnel Director, Bureau of Personnel or representative.
9. One Uniformed Member in Charge of Medical Division.
10. A quorum shall consist of at least 50% of the membership.

NOTE: Members shall note the monetary amounts listed under subsection disbursements.

Second Medical Opinions Free—Pro Bono Medical Panel

The Pro Bono Medical Panel, which is a group of highly regarded independent physicians, are experts in their specialties, and will render a second opinion to our members and their immediate family, without charge. The initial consultation will be provided free to uniformed members with non-service connected medical conditions and their legal spouses or minor children. (DO #53 of 1992)

1. Overview: The panel consists of a group of physicians who recognized the work that the New York City Firefighters are doing and wished to show their appreciation. This group of doctors has agreed to act as Pro Bono (free voluntary service) consultants to our members. Since this program was established, many members have made successful use of this service. This is a group of physicians who are highly regarded experts in their specialties to act as medical consultants for our members. These specialties include pediatric surgery, ophthalmology, internal medicine, cardiology, neurological surgery, pediatrics, dermatology, plastic surgery and reconstructive surgery, gastroenterology, pulmonary medicine and sports medicine. Nearly every member of the panel is published; many currently serve or have served on medical school faculties; all are board-certified.
2. How to apply: The requesting member shall telephone the BHS Chief Medical Officer (CMO) and ask for an application. The CMO will provide members with an application to be completed and returned to B.H.S. This confidential application will include:
   • Member’s name, rank, social security number, assigned unit, home address, and phone number.
   • Patient information if other than member. If the patient is a spouse, he/she must be aware and agree with the request.
   • Medical reason for request. This confidential request must also state: “I hereby request that my application for a medical consultation for (myself, my spouse or minor child) be considered.”
3. If Request is Granted: a favorable endorsement will be forwarded to the CMO: A detailed medical report describing the patient’s medical condition signed by the current treating physician, the physician who regularly treats the patient. The member must inform the current treating physician that the panel consultant will send a written report of their medical findings and opinions to the current treating physician. The Office of the Chief Medical Officer will select the appropriate panel physician.
4.  Pro Bono Physician Consultation: After the examination, the panel physician will discuss their medical findings with the member-patient or with the member and the dependent-patient. The panel physician will forward a written report to the current treating physician and refer him/her back to the current treating physician. If evaluation extending beyond the visit is necessary, or if medical care by a panel physician is decided upon by the member, then a separate financial agreement would have to be made between the member and the panel physician. In most cases, an insurance assignment will be accepted as full payment.

Fire Family Transport Foundation

1. Overview: The FFT vehicle (Dept Order 146 12/3/93) is intended to ensure that members who are seriously injured in the line of duty have their families transported to medical institutions in a way befitting their special needs—at no cost. The FFT vehicle was donated to the Fire Department by the Fire Family Transport Foundation, Limited, a non-profit corporation founded by members of the Department, headed by Lt Patrick Concannon of L-111. The FFT vehicles are housed in the FD Facilities & various firehouses, the number of vehicles and models changes from time to time.
2. Activation: Captains wishing to use any of these vehicles should call the Division, which would initiate the procedure. To authorize activation during business hours, request the Executive Officer to Chief of Dept, at other times call the Notification Desk, where the Citywide Command Chief will ensure activation. The Captain: assigns someone to organize members who will be responsible for driving FFT vehicles, usually on a 24-hour basis, assign the drivers beepers and have them keep a log of when and where they drove and money spent. Drivers should be given an expense account for the family’s needs, and is responsible for vehicle security, fuel/oil, daily cleaning. The FFT may not be used for personal use. It is also the company’s responsibility to keep these vehicles clean and vacuumed. They should never be returned to the company where they are stored with cans and garbage in them. These vehicles belong to us and should be returned clean, with a full tank and ready to be used by the next unit who needs them.
3. Staffing: The FFT shall be staffed as follows:
   • Level 1 – Life-Threatening Injury to Member: The member assigned to operate the FFT is designated FFT firefighter. The primary strategy will be to utilize one member from the injured member’s company to act as an aide to the family and operator of the FFT. This firefighter will be taken off the chart and detailed to the FFT. This detail shall continue for up to a period of 96 hours following hospitalization. The family may request a firefighter assigned to another company as FFT firefighter. Either way, that firefighter will be taken off the chart and assigned to the FFT. In all cases, the injured member’s Company Commander shall approve and supervise.
   • Level II – Critical Condition: Under this condition, the criteria utilized for Level I will be implemented for the first 24 hours of hospitalization.
   • Level III – Serious/Stable Condition: The injured member’s Company Commander must make a request for use of the FFT to the Fire Commissioner or Chief of Department.
4. Long term light duty firefighters may be used. Their selection will be determined by the Fire Commissioner or Chief of Department. The FFT Advisory Board may make recommendations on the selection of light duty details.
5. Where it is determined that light-duty firefighters cannot be utilized, off duty members may be utilized as FFT Firefighters on a voluntary basis.
6. The injured member’s Company Commander shall approve the selection of volunteers.
   • Special Circumstances: The Fire Commissioner or Chief of Department reserves the right to alter the criteria for length and type of staffing (detail or volunteer) depending on the injured member’s medical needs, needs of the family and Department resources. This applies to all levels of service (I, II, or III).

Inoculations & Immunizations

The Department’s immunization and inoculation program is an excellent free benefit that can save you and your family from severe illnesses and high medical costs. The BHS administers tuberculosis tests and updates other needed immunizations at no cost, including tetanus and Hepatitis B. The BHS maintains your immunization & inoculation records in its computer system and will provide any written documentation you request. You may want to bring your UFA Locker Medical Monitoring Card with you for your Annual Medical. The BHS will enter any inoculation dates into its system for you so the BHS can automatically remind you of needed boosters, etc. whenever you take your Medical. Inoculations may also be given for biological or chemical agents in response to terrorist attacks. These are often done on a schedule or by emergency announcements in various firehouses.

Hepatitis inoculation is a series of 3 or 4 injections which protect you and your family. It has been reported that the most accurate results (to see if you are protected from Hepatitis) are measured if the testing is done after a three month wait (after your last shot). About 20% of those taking the series require the 4th shot. Currently (2005), all newly hired firefighters are offered Hepatitis B inoculations. BHS Nurses will be sent to Probie School to administer the first two inoculations for Hepatitis B-if a probie is not immunized already. Probies will also receive inoculations for measles, rubella and mumps, if needed. Their third Hepatitis B inoculation is administered at their 5th Grade Medical or next Annual Medical. Booster inoculations will be administered to any member whose immunity levels are too low. If you are concerned about the prevention of these illnesses, contact the FDNY BHS to see if/when any program is active. It’s a generous benefit. Make sure you take full advantage of it!

Counseling Services

• Counseling Services Unit (CSU) The CSU is a unit of the FDNY Bureau of Health Services (BHS). Its purpose is to assist members with the intention of restoring the member to a healthy state of mind so members may perform their duties safely. If you are experiencing any problems that you feel may be interfering with safely performing your duties, or causing a danger to your health, the CSU may be able to help you, and grant time off for you to address a particular issue. The CSU has assisted many members work their way through some of the following issues: dealing with serious injuries, death or serious illness of loved ones, marital problems, trauma stress, feeling down, depression, suicidal thoughts or other mental issues, referrals to therapists, and addressing substance/alcohol problems. See ‘FDNY’ Section (‘BHS’ Chapter: Counseling Services Unit’) for more info.

• Confidential Counseling Services Don’t Want FDNY to Know? The UFA Health & Safety Office keeps note of programs available through outside counseling sources, where no person in the Dept., CSU, or the UFA will have any ability to know you are going for treatment anonymously. If you do not want to personally make the call for help, you can have your Delegate (or a concerned friend or family member) anonymously contact the UFA Health & Safety Office for you.

Disability Rights & Leave

Maternity Leave & Family Leave Act

In accordance with Federal Law under the Family and Medical Leave Act 1993 and DO #138 of 1993 members are entitled to 12 workweeks of unpaid leave during any 12-month period due to a new birth, or major illness of dependents, in accordance with certain definitions. This is in addition to other leave you are entitled to with pay while you are pregnant and after birth. See Legal & Rights Book (Civil Rights & Freedoms chapter) & FDNY Book (Bureau of Health Services Chapter: Maternity Leave) for more specific info.

Reasonable Accommodation per Americans with Disability Act (ADA)

The ADA defines Disability as: “someone who has a physical or mental impairment which substantially limits one or more major life activities; or has a record of such physical or mental impairment; or is regarded as having such a physical or mental impairment.” Disabled persons have certain employee rights under Federal Law. Under certain circumstances, employers must provide work assignments to disabled employees if such positions can be reasonably accommodated. See Legal & Rights Book (Civil Rights & Freedoms chapter) for more info.

Line-of-Duty Injuries (LODI)

Medical Treatment: Who Pays?

The FDNY pays directly for any medical services active members receive in connection with a LODI—but ONLY if you receive prior approval. Always get written authorization from BHS before you go for outside consultation or medical treatment for a LODI Injury. If you seek your own treatment without prior written authorization and then attempt to have the bill paid by the FDNY—don’t waste your time, trouble, phone calls or stamps—because all your attempts at reimbursement or payment will prove fruitless! Do it right the first time.

• Active: You must have prior written authorization (except for emergencies) from the FDNY’s Bureau of Health Services (BHS) if you expect the FDNY to pay for any treatment of a LODI. If you have authorization, the Dept pays 100% of all authorized treatment and diagnostics for LODI injuries for active members. Medical services for LODI are NOT covered by your NYC Health Plan while you are an active member!
• Retired: Medical services for LODI are NOT covered by the FDNY after your retirement date! Instead, your normal NYC Health Plan will cover it, subject to your plan’s limitations. In other words, your LODI coverage will most likely not be as thorough once you retire.

LODI Drug Prescriptions

UFA Drug Card: Never use your SBF drug plan for any line-of-duty injury (LODI) drug prescriptions— ever! If you do this, the cost comes directly out of the limited money the City contributes annually into your SBF dental, optical, prescription drug, anesthesia, hearing aid, and other supplemental health benefits plan. It’s your money. Don’t waste it—the Dept is required to pay it! Here’s how the LODI prescription drug reimbursement program works:

• Active Line-of-Duty—FDNY Pays —Line-of-Duty Drug Card: Whenever you are prescribed drugs for a Line-of-Duty Injury, you must use your FDNY LODI drug card or WTC drug card to fill the prescription. Do NOT use your UFA SBF drug card.
• Retired Line-of-Duty: LODI drugs are NOT covered by the FDNY after your retirement date! Instead, the UFA SBF or Medicare (see Medicare-Eligible Retirees section of the NYC Health Plans Chapter in the Health Book) will cover it, subject to your plan’s limitations. EXCEPTION: Drugs for WTC-related injury are covered by your WTC Drug Card.

WTC Related Drug Prescriptions

Prescriptions for WTC-related illnesses or injuries that have been verified by the FDNY BHS are currently being covered by the WTC Prescription Drug Card. This includes retired members who were active during their time working at the WTC or other locations covered under the WTC Presumptive Illness Bill. Contact the FDNY BHS regarding the WTC Medical Monitoring Program. Members must participate in the monitoring program to be eligible.

Contacts List

• UFA – Uniformed Firefighters Association (UFA) 204 East 23rd Street, New York, NY 10010 www.UFANYC.org
• SBF – Security Benefits Fund (SBF), 3rd Floor, Phone: 212-683-4723 Email: SecurityBenefitsFund@UFANYC.org
• UFA Compensation Accrual Fund (Annuity), 3rd Floor, Phone: 212-683-4723, 1, x5901 #
• Group Life Insurance Office, 3rd floor, Phone: 212-683-4723, 1, x5903/05 #
• Surgical Assistance Fund (see FDNY)
• FDNY – N.Y.C. Fire Department Address: 9 Metrotech Center, Brooklyn, NY 11201-3857
• Pension Benefits Unit 718-999-2324 (Pensions/Benefits Analyst)
• Personnel Office 718-999-2164
• Chief of Department, Executive Officer 1-718-999-2068
• Notifications Desk (Citywide Command Chief) 1-718-999-2094
• Death Notifications
  • Retired FDNY Member 1-718-999-2320/2321
  • Active FDNY Member 1-718-999-2094/2095
• Health Benefits Unit (Camille Isaacs) 719-999-2196
  • ERB (Employee Health Benefit Application)
  • FDNY Health Desk (request of forms)
• Bureau of Health Services (BHS) 1-718-999-1917
  • Medical Office (2nd floor)
  • Medical Leave Desk (automated) 718-330-2204
  • Postponements 718-999-1918/19/20
  • Chief Medical Officer: 718-999-1933
• Line-of-Duty Injury Prescriptions Submissions & Infectious Control
  • Justin Lashkow, Head Nurse 1-718-999-0227
• Welfare Fund 718-999-1888/9
• Honor Emergency Fund: 718-999-1216 (VM), 718-999-2531/32
• Surgical Assistance Fund (questions, forms) Kathleen Oliveri
  • Tel: 718-999-1252 (VM available 24/7), Fax: 718-999-0106
• EHS – Eckerd Pharmaceutical Services – UFA Drugs
  • Claims Submissions, PO Box 2860, Pittsburgh, PA 15230-2860
  • (for Mail Order) Express Pharmacy Services, PO Box 270, Pittsburgh, PA 15230-9949
  • Website: www.EHS.com
  • Customer Services: 866-832-0563 (for Claim Info, Participating Pharmacies, Diabetic Drug Info)
  • Hearing Impaired: 800-238-0756
  • EHS Healthline: 866-744-4848 (health & medication questions)
  • Specialty Pharmacy Services: 800-621-4786 (complex or chronic medical conditions)
• National Prescription Administrators (NPA) – PICA Drugs
  • Express Scripts/NPA (PICA Drug Administrator) Tel: (800) 467-2006

NYC Health Benefits Program (Retired Members)

• Administrative Office, 40 Rector Street, 3rd Floor, New York, NY 10006
  • Phone: (212) 513-0470
  • NYC Website: www.nyc.gov/html/olr
  • Domestic Partnership Liaison Unit, OLR: Active FFs 212-669-2208, Retired FFs (212) 513-0470

Dental Services – UFA Plan

• Healthplex & Dentcare
  • 60 Charles Lindbergh Blvd, Uniondale, NY 11553
  • Tel: (800) 468-0608, (516) 542-2200
• United Dental Systems (UDS)
  • 48 West 21st Street, New York, NY 10010
• UDS Programs, Tel: 212-675-5745, Fax: (212)675-1147

AFLAC

• Cancer (NY Customer Service) 1-800-366-3436
  • Personal Accident Expense Plan 1-800-366-3436
• AFLAC Website: www.aflacny.com

Catastrophic Insurance, Seabury & Smith/Marsh Affinity

• Phone: Customer Service 1-800-503-9230
• Phone: Ariel, 1-800-229-5227 x.324
• Fax: 1-847-503-9230, 1-847-803-1653
  • 1440 Renaissance Drive, Park Ridge, Illinois 60068-1400
  • Hours: M-F, 8:15am-5:00pm
• e-mail: custsvc2@seaburychicago.com
• Web: www.seaburychicago.com/plans/ufa (applications/brochures)

New York State Department of Health (Concerns, Complaints)

• Hospital Care Complaints:
  • NYC Metropolitan Area 1-212-268-6554
  • New Rochelle Region 1-914-654-7011
  • Long Island Area 1-631-851-4300
• Managed Care Complaints: 1-800-206-8125
• Office of Professional Medical Conduct (OPMC): 1-800-663-6114

Office of the City Clerk

• 1 Centre St, 2nd Floor South, New York, NY 10007
• Phone: 212-669-8190

Municipal Labor Committee (MLC)

• Tel: (800) 467-2006

NYC Deferred Compensation Form

• Request forms at 212-306-7760, or visit www.nyc.gov/deferredcomp, click “Library” then choose “457/401(K)PlanChangeForm.pdf”
• Send form to: DEFERRED COMPENSATION PLAN
  Bowling Green Station, PO Box 93, New York, NY 10274-009

NYC Health Plan Carriers

• Aetna QPOS
  • 800-445-8742
  • www.aetna.com
• Aetna HMO
  • 800-445-8742
  • www.aetna.com
• CIGNA HealthCare
  • 800-832-3211
  • www.cigna.com
• Empire HMO (NY)
  • 800-767-8672
  • www.empireblue.com/nyc
• Empire HMO (NJ)
  • 888-476-6986
  • www.empireblue.com/nyc
• Empire EPO
  • 800-767-8672
  • www.empireblue.com/nyc
• GHI-CBP/Empire BlueCross/BlueShield:
  • GHI: 212-501-4444 | www.ghi.com
  • Empire: 800-433-9592 | www.empireblue.com/nyc
  • NYC Healthline: 800-521-9574 (for emergency hospital admission)
• GHI HMO
  • 877-244-4466
  • www.ghihmo.com
• HIP Prime POS 
  • 800-447-6929
  • www.hipusa.com
• HIP Prime HMO 
  • 800-447-6929
  • www.hipusa.com
• HIP/HMO
  • 800-HIP-TALK
• Heath Net
  • 800-441-5741
  • www.healthnet.com
•  Vytra Health Plans
  • 800-448-2527
  • www.vytra.com