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Supplemental Benefits

The PBA Health and Welfare Fund provides supplemental benefits in addition to its core Prescription Drug, Dental, and Vision Plans.  These supplemental benefits include:

  • Catastrophic Benefit
  • Durable Medical Equipment Benefit
  • Life Insurance Premium Contribution
  • Legal Services
  • Cost Sharing Reimbursement

Catastrophic Benefit

In order to provide a measure of financial relief for members with high out-of-pocket costs resulting from unforeseen expenses related to out-of-network charges, the Fund provides a catastrophic benefit. 

Members who are enrolled in the GHI-CBP Program are eligible for reimbursement for high out-of-pocket costs.  A portion of out-of-pocket costs incurred by the member or the member’s eligible dependents may be reimbursed if all of the following conditions are met:

  • The member is enrolled as the subscriber/policy-holder in the GHI-CBP Program; and
  • The out-of-pocket costs for which reimbursement is sought were paid for services performed by a non-participating provider; and
  • The out-of-pocket costs for which reimbursement is sought were paid for services that are covered by the GHI-CBP Program; and
  • The out-of-pocket costs, for which reimbursement is sought, were not covered by or reimbursed by another group health plan or other party.

For more details about the Catastrophic Benefit, please refer to the Catastrophic Expense Reimbursement Benefit Summary and Schedule of Benefits which can be obtained, by contacting the PBA Funds Office.  Please also refer to the Cost-sharing Reimbursement Schedule of Benefit which can be obtained, free of charge, by contacting the PBA Funds Office.

Durable Medical Equipment

Members may apply for reimbursement of out-of-pocket costs for durable medical equipment.  Durable medical equipment is equipment that is:

  • Expected to last for at least three (3) years; and
  • Can be used repeatedly; and
  • Can be used in the home; and
  • Normally used for a medical purpose; and
  • Medically necessary for the patient; and
  • Generally not useful in the absence of an illness or injury.

Examples of durable medical equipment include:

  • Wheelchairs
  • Walkers
  • Power scooters
  • Home oxygen equipment
  • Hospital beds 

In addition to items that are typically used in the home, reimbursement may also be available for foot orthotics and prosthetics. 

The Fund will reimburse you for up to eighty percent (80%) of your out-of-pocket costs for durable medical equipment.  There is a maximum family benefit of $1,000.00 per twelve (12) month period and a lifetime maximum of $3,500.00 per family.

The Emergency Medical Squad also provides services and equipment including wheelchairs, crutches, and other medical equipment/devices.  Ambulance service is also available.  The Emergency Medical Squad can be contacted at 718-626-9320.  

Requirements for Reimbursement for Durable Medical Equipment:

  • The member is enrolled as the subscriber/policy-holder in the City of New York Health Benefits Program; and
  • the out-of-pocket costs for which reimbursement is sought were not covered by or reimbursed by a group health plan or other party.

In order to receive reimbursement for durable medical equipment, please contact the PBA Funds Office to obtain a claim form.  Forms are also available on the PBA’s website at www.nycpba.org, under the Benefits section.

Life Insurance Premium Contribution

The Patrolmen’s Benevolent Association of the City of New York sponsors an insurance program for its active members.  The current amount of life insurance coverage for active members is $250,000.00.  The PBA Health and Welfare Fund contributes premium payments for $50,000.00 of this coverage for each active member.  For more information on member life insurance and life insurance coverage for dependents, please contact Aetna at 1-866-428-8019.

Legal Services

The PBA Health and Welfare Fund provides legal counseling and representation for certain pension and disability matters.  Please contact the PBA Funds Office for details.

The PBA Health and Welfare Fund contributes to the Legal Services Fund of the Patrolmen’s Benevolent Association of the City of New York (Legal Services Fund).  The Legal Services Fund provides job-related legal services for active Police Officers.  Please refer to the Legal Services Fund Plan Description for more details.

Cost Sharing Reimbursement

The PBA Health and Welfare Fund reimburses members for all or a part of their out-of-pocket expenses for deductibles, co-payments, and coinsurance that are required by health insurance plans participating  in the City of New York Health Benefits Program.  Reimbursement is available for cost sharing payments made by the member and his/her dependents for in-network services.  The reimbursement level for each type of cost-sharing described above may not be equal to the entire cost-sharing amount required by your carrier.  Please refer to the Cost-Sharing Reimbursement Schedule of Benefits which can be obtained by contacting the PBA Funds Office.

How to Obtain Cost-Sharing Reimbursement

In order to receive cost-sharing reimbursement, mail copies of your explanation of benefits or benefits statements from your health insurance carrier to the PBA Funds Office.  Please direct all documentation to the Health Related Benefits Department.  All documentation must be submitted to the PBA Funds Office within one (1) year of the date of service.