Local 22 Firefighters/Paramedics

215 440-4421 / 22

415 N 5th St. Philadelphia., PA 19123.

Dependents Eligibility and Enrollment

Who is Eligible 

You and your dependents are eligible for coverage beginning with your first day of employment with the Fire Department.

i. Employees

If you are employed in a position with the Fire Department that is represented by the IAFF Local 22 Union you are eligible for benefits. You may also be eligible for benefits if you are employed by an employer who has entered into a participation agreement with the IAFF Local 22 Health Plan or if you are employed by the IAFF Local 22 Union or the IAFF Local 22 Health Plan.

ii. Retirees

Upon retirement, you are eligible for certain benefits for five (5) years provided you meet the age and service requirements described below:

  1. you have reached age 45 and are eligible to participate in Plan X; or
  2. you have reached age 50 and are eligible to participate in Plan 87 (Plan A); or
  3. you have satisfied the minimum requirements to qualify for a pension benefit through the City uniformed pension plan; or
  4. you were a participant in the City of Philadelphia pension fund for a least ten (10) years; or
  5. you were employed by the Local 22 Health Plan or the Local 22 Union for a minimum of 35 hours a week for at least ten (10) consecutive years immediately preceding your retirement and you are at least 55 years of age when you leave employment with the Health Plan or the Union
    1. any Health Plan or Union employee (or their eligible dependent) who is eligible to enroll in Medicare, must enroll in Medicare Part A and Part B to qualify for the five (5) years of City-funded coverage City-funded health coverage is limited to this five (5) year period, regardless of whether you would qualify for a pension under more than one of the requirements listed above. If you die, your eligible dependents are entitled to continue coverage from the Plan for the balance of the five years of coverage remaining at the time of your death, provided they continue to meet the definition of “eligible dependent.”

Deferred Retirement Benefits 

You may elect to defer your eligibility for five years of City-funded coverage until a later date. This election to defer coverage must be made when you retire and you can only re-enter coverage status one time. If you have access to other health coverage when you retire, and are interested in additional information on deferring your coverage with the Plan, please contact the Plan office prior to your retirement to discuss this option.

Service Connected Disability Retirement Benefits 

If you are eligible for a service-connected disability pension from the City of Philadelphia and were a participant in the pension fund for one (1) day immediately prior to retirement, you are eligible for five (5) years of retiree health coverage.

Non-Service Connected Disability Retirement Benefits 

If you are eligible for a non-service-connected disability pension from the City of Philadelphia and were a participant in the pension fund for at least ten (10) consecutive years immediately prior to retirement you are eligible for five (5) years of retiree health coverage.

Your City-sponsored retiree health coverage runs concurrently with your eligibility for continuation coverage under COBRA. This means that at the end of your five years of City-funded coverage you will NOT be offered a COBRA election. Please refer to “Continuation Coverage under COBRA” for additional details.

iii. Eligible Dependent of Employee who Dies in the Line of Duty 

If you die in the line of duty, your widow or widower is eligible to receive lifetime benefits from the Plan. Any other eligible dependents will be covered for as long as they meet the eligibility criteria of the Plan, e.g., dependent children will be covered until they reach age 26.

iv. Eligible Dependent of Employee who Dies in Active Service but Not in Line of Duty 

If you die while in active service but not in the line of duty, your spouse and other eligible dependents will remain eligible for coverage as if you had retired on the date of your death.

v. Eligible Dependent of Employee who Dies while on Approved Leave of Absence 

If you die prior to retirement, while on an Approved Leave of Absence, your spouse and other eligible dependents will remain eligible for coverage as if you had retired on the date of your death.

vi. Eligible Dependent of Retired Employee 

If you are a retiree and die while eligible for health coverage your spouse will be covered for the remaining period of your retirement coverage. Any other eligible dependents will be covered for as long as they meet the eligibility criteria of the Plan.

Event Who is Covered Duration of Coverage
Members dies after Retirement Surviving spouse and eligible dependents If you retire and die while eligible for health coverage your spouse will be covered for remaining period of your retirement coverage, including the 5 years of coverage provided by the City and any additional months of coverage you “Purchased” when you retired through conversion of your unused sick time. Any other eligible dependents will be covered as long as they meet the eligibility criteria of the Health Plan (e.g. dependent children will be covered until the end of the month in which they turn 26)
Member dies in the Line of Duty while in Active Service Surviving spouse and eligible dependents If you die in the line of duty, your spouse may be eligible for lifetime benefit coverage under the Health Plan. Any other eligible dependents will be covered for as long as they meet the eligibility criteria of the health Plan (e.g. dependent children will be covered until the end of the month in which they turn 26). Your spouse will always be eligible for the benefits you would have as a retiree, including the 5 years of coverage provided by the City plus any additional months of coverage you could “purchase” through the conversion of unused sick time. But lifetime coverage will cease in the event your spouse remarries after your death.
Member dies in Active Service but not in the Line of Duty Surviving spouse and eligible dependents If you die while in active service but not in the line of duty your spouse will be eligible for coverage as if you had retired on the date of your death. This includes the 5 years of coverage provided by the City plus any additional months of coverage you could “Purchase” through the conversion of unused sick time. Any other eligible dependents will be covered as long as they meet the eligibility criteria of the Heath Plan (e.g. dependent children will be covered until the end of month in which they turn 26)

Upon your initial eligibility, the Plan will provide you with enrollment cards and application forms. You will not be eligible for health benefits until you complete and return these documents.

Enrollment in the Health Plan is not automatic. Until you complete the enrollment and application forms neither you nor your eligible dependents will be covered for health benefits

Your Eligible Dependents 

Coverage is for you and your eligible dependents. Eligible dependents are your:

  • Legally married spouse
  • Children under age 26
  • Handicapped children of any age who are chiefly dependent upon you for support and are unable to earn a living because of mental or physical handicap

Your children are your biological children, legally adopted children from the date of placement in your home, and any children for whom you are legally bound, as confirmed by a court order, to provide full and permanent support. A child may be covered until the end of the month in which he or she reaches the age limit of 26.

Your spouse or child is not eligible while they are on active duty in the armed forces of any country.

Stepchildren may be enrolled if you demonstrate that you stand in a parent-child relationship with the child. Your stepchildren are the children of a person to whom you are legally married where you are not the biological parent. You may demonstrate a parent-child relationship by providing your marriage certificate to the child’s parent as well as a copy of the child’s birth certificate. There is a fee of $65 per child per month to enroll your stepchild in the health plan, with this amount subject to change when reviewed annually by the Board of Trustees. This fee is due on or before the first day of the coverage month and failure to provide timely payment will result in a late fee of $25 per child for each month that your payment is delinquent. Continued delinquency in remitting this fee may result in termination of the stepchild’s health coverage. Coverage will also terminate in the event you and your step child’s biological parent divorce.

Waiver of Fee 

You may apply for an annual waiver of the fee to enroll your stepchild if you furnish the following documentation to the Plan each year:

  • If the child is under the age of 18, a current child support order that substantiates that neither you nor your spouse is receiving any financial support on behalf of the child; and
  • Evidence that the child’s biological parents cannot provide health benefit coverage; and
  • A copy of your tax return showing that you, or your spouse if filing separately, claim the child as a dependent. The child must be claimed as a dependent within your household; and
  • a “stepchild affidavit” which affirms that you meet all requirements for eligibility, advises your liability if the stepchild is not eligible, and also affirms that neither you nor your spouse receive any financial support from any source for the child

Grandchildren 

You may enroll your grandchild if you provide the Plan with an official copy of an order from a court of competent jurisdiction awarding you permanent, legal and sole physical custody of the children.

Handicapped Children over age 26 

The Plan will continue to provide health coverage for a child who is mentally or physically handicapped and incapable of supporting him or herself after their 26th birthday for as long as the child remains handicapped and unmarried and the following requirements are met:

  • the child must have been handicapped and an eligible dependent under the Plan prior to reaching their 26th birthday
  • you must provide medical or other documentation of the child’s Examples of documentation include a statement from a treating physician that the child is handicapped; or a determination from the Social Security Administration that the child is handicapped.

The Trustees will make the final determination, based on the documentation submitted, on whether the handicapped child can continue coverage under this provision.

Qualified Medical Child Support Order (QMCSO) 

Your children also include children under age 26 for whom you are required to provide health care coverage under a Qualified Medical Child Support Order (QMCSO), regardless of where the children reside. A QMCSO is any judgment, decree, or order issued by a court requiring you to provide child support or health care coverage for a child.

Proof of Eligibility 

As a condition of receiving coverage and benefits through the Plan, you must comply with reasonable requests for verification of initial and continuing eligibility. Married participants will be required to supply proof of marital status. If your child is handicapped, you must provide written evidence of the child’s handicap within 31 days after his or her attainment of age 26. When required, you must provide proof of the continuation of your child’s handicap to the Plan.

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