415 N 5th St. Philadelphia., PA 19123.
You and your dependents are eligible for coverage beginning with your first day of employment with the Fire Department.
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.
Upon retirement, you are eligible for certain benefits for five (5) years provided you meet the age and service requirements described below:
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.
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.
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.
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.
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.
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.
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
1. What dependents are covered under the Health Plan?
• legally married spouse
• biological and adopted children under age 26
• handicapped children of any age
• Qualified Medical Child Support Order (QMCSO): children under age 26 for whom you are required to provide health care under a QMCSO
• stepchildren under age 26 (there is a cost of $65 per stepchild per month to provide coverage: contact the Health Plan for additional details)
2. When can I add a dependent to the Health Plan?
• If you get married, you need to add your spouse within 30 days of the date of your marriage
• If you have a new baby, you need to add the baby within 30 days of the date of birth
• If you adopt a child, you need to add the child within 30 days of when the child was placed in your home for adoption
If you don’t add a new dependent within 30 days of the marriage/birth/placement, you will have to wait until the Health Plan’s annual Open Enrollment, which is November each year.
EXCEPTION: If your dependent is covered under another health plan and loses that coverage, you can add that dependent any time throughout the year as long as you do it within 30 days of when they lost their other coverage.
Coverage for you dependent will start on the 1st day of the month after we receive your documentation
3. How do I add a dependent to the Health Plan?
The Form and Instructions are on the “Home Page” of this website – under the “FORMS Header” -“Dependent Forms Instructions”.
You need to call the Health Plan office to add a dependent for instructions to provide the proper documentation electronically or come down in person with the proper documentation. Your enrollment card needs to be updated by you and there is documentation that’s required (see below).
4. What documents do I need to add a new dependent?
• Spouse – copy of your marriage certificate and the spouse’s Social Security Number (we don’t need to see the Social Security card)
• Biological Child – copy of your child’s birth certificate showing you as the biological parent and the child’s Social Security Number (we don’t need to see the Social Security card)
o If you don’t have the state-issued birth certificate within 30 days of the baby’s birth, we will accept the hospital-issued certificate until you receive the state document
• Adopted Child – copy of the child’s birth certification, Social Security number, and legal documents indicating the child has been placed with you for adoption
• Handicapped Dependent – you must provide medical or other documentation of the child’s handicap. 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 child must have been handicapped and an eligible dependent under the Plan prior to reaching their 26th birthday
5. What happens to my spouse’s coverage if we divorce?
It is your responsibility to notify the Health Plan immediately when you are divorced and to provide a copy of your divorce decree. If you don’t let us know you’re divorced, and your ex-spouse continues to use Health Plan benefits, it is YOUR responsibility to repay the Plan for benefits used by a non-eligible dependent.
Coverage is for you and your eligible dependents. Eligible dependents are your:
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.
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:
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.
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 Trustees will make the final determination, based on the documentation submitted, on whether the handicapped child can continue coverage under this provision.
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.
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.
Copyright © 2018 Local 22 Fire Fighters & Paramedics Health Plan. All Rights Reserved.