Rules & Benefits Information
General Provisions,
Life Insurance Benefits,
Dental Benefits,
Optical Benefits,
TV Rental Benefits,
Prescription Plan, Blood
Bank, Physical Exam Benefit
- When did the Welfare Fund take effect:
The Welfare Fund started January 11, 1968 and anyone on the job from that date on is covered.
- Who is eligible:
All members on the job from the date stated above including Fire Fighters, Lieutenants, Captains, Deputy Commissioners and Commissioner.
- When do new Fire Fighters become eligible:
New Fire Fighters and reinstated Fire Fighters become eligible on the date of appointment or reinstatement in UFFA.
- How long does eligibility continue:
Eligibility continues for the life of the member and his widow until age 65 or she remarries.
- Are members of my family eligible for benefits:
Your wife and dependent children will be eligible for dental, optical, T.V. rental, blood bank from the welfare fund. Dependent children are defined as a fire fighter's children who have not reached their 25th birthday and are dependent on him for support and maintenance.
- Will I have to pay anything at all for these benefits:
Yes, retired members will be obligated to pay for welfare benefits for themselves and their dependents. Once a retired member drops out of the welfare fund, he will not be allowed back in. This provision takes effect January 1, 1983.
- How do I make a claim for benefits:
Death Benefit:
Notify the UFFA of the death and a representative from the UFFA and Welfare Fund will contact you for further details.
Optical Benefit:
Both member and optometrist or ophthalmologist or both fill out optical form, sign and date it. Return form to the UFFA Welfare Fund for payment.
Dental Benefit:
Both member and dentist fill out dental form, then sign and date it. Return completed form to UFFA Welfare Fund.
T.V. Rental Benefit:
After patient is released from hospital you will receive bills for T.V. rental. When you receieve a billing saying "This is the Final Bill", turn this one in to the UFFA Welfare Fund.
Blood Bank:
When the need for blood arises, notify hospital that you are a member of the UFFA Blood Bank. Also, notify the UFFA representative of the blood bank.
Prescription Benefit:
You must submit between July to June for the previous year. Send in your receipts or a yearly readout from your pharmacy.
For Active & Retired Members And Dependents
The WELFARE FUND provides life insurance coverage for each member.
Retired members who retired before 1989 ...............$5,000
Active & retired members who retired after 1989 .....$15,000
The WELFARE FUND also provides voluntary insurance plan. Any new active member may purchase the NYSFF PLAN. A new member must sign up within thirty-one (31) days from his first day as a union member. Anytime after that you will be required to pass a medical examination to become eligible. Plan is paid through payroll deduction.
The amounts of life insurance are as follows:
Member .............. $25,000 to $150,000
Spouse .................$20,000
Children ...............$4,000
See Welfare Chairman about payroll deduction and premiums.
When a member retires he may still carry the voluntary insurance, provided he has applied within the thirty-one days after retirement. The amounts are reduced by 50%. The voluntary insurance ceases at age 70.
For Active and Retired Members and Dependents
The Dental Benefits provided by the Welfare Fund for services performed by the Dentist, are payable at the rate of 80% or 50% of the maximum allowable charges.
Example:
Assume that your Dentist has made full dentures, both immediate and permanent, for each jaw for which he is charging $650.00. The maximum allowed for this service as stated in the Schedule of Allowances is $250.00 for each jaw, for a total of $500.00. The Dental Plan pays 50% of the remaining allowable charge as follows:
$500.00 x 50% = $250.00
Thus, in this example, the Dental Plan pays $250.00 of the Dentist total charge of $650.00.
The Plan is an indemnity benefit provided by the Welfare Fund. This means that you use the Dentist of your choice. The benefits are paid either directly to you or you may assign the benefits to your Dentist. If you wish to assign your benefits to the Dentist there is a space on the claim form for this purpose. Your benefits are then paid directly to him. You can obtain a Claim Form at your own Fire Company.
These forms must be completely filled out or they will be returned to you. The member must fill out boxes#1 to #15 and sign form. The dentist must fill out boxes #16 to #31 and date and sign form. Dentist keeps pink copy and the white and canary copies return to UFFA Welfare Fund.
Survivors Benefit:
If a covered member dies while insured, his dependents' Dental Insurance will
continue, provided premium payments are made with respect to any of his insured
dependents while the policy is in effect. Coverage will continue until that
person marries, or otherwise ceases to be an eligible dependent.
DENTAL PROVISIONS AND RULES
- Charges over the Schedule of Fees or for work not covered by the schedule
are the members' sole obligation.
- All Claims must be turned in no more than 30 days after completion of
dental work.
- Retired members and dependents electing to be in Dental Plan must pay a
yearly fee (whatever amount specified). Once a member or dependent drops out
they will not be allowed back in. (See general provision #6).
- Dependents Defined:
1. Your wife except if you are legally separated;
2. Dependent children of eligible employees and other children whom the employee is legally entitled to claim as a dependent child on his federal income tax return, from the age of ten (10) days until their nineteenth (19) birthday; twenty-fifth (25) birthday, if a full time student at an accredited college or university, the child must meet the age requirements at the time the service is performed;
Note: A child who is dependent upon an eligible employee for support and maintenance and who is mentally or physically incapable of earning his (her) own living shall be deemed to be an eligible dependent without regard to the age limitation so long as the child remains so incapacitated and dependent, provided that he (she) was a covered dependent under this plan at the time he (she) would otherwise have become ineligible and further provided that initial due proof of such incapacity is received by the Fund within thirty-one (31) days after it is requested and that due proof of the continuance of such incapacity and dependency is further furnished whenever reasonably requested thereafter.
SCHEDULE OF DENTAL BENEFITS
Plan Effective Date: March 1, 1976 For Members and Dependents
Maximum Dental Benefit (in any calendar year) ............ $1500.00
Maximum Orthodontic Benefit (Lifetime) ......................$1500.00
Maximum Periodontal Benefit (Every 4 Years) .............$1500.00
Dental Co-insurance Factor:
- 50% - for orthodontic appliances and treatment; inlays, gold fillings and
crowns; dentures and bridgework (other than repair of dentures and
bridgework).
All other charges will be paid at 80% of our Scheduled Dental Fees.
- Posterior crowns and bridgework are usually ineligible for benefits unless
they:
A. Replace tooth extracted after insurance inception.
B. Are used to cover tooth which had root canal treatment.
- A signature in "release of information" allocated area, on left, is
mandatory. Forms will be returned which do not have such signature.
- Pre-treatment estimates are valid for 60 days only and will not be honored
after such period. A new estimate must then be re-submitted.
- Claims must be submitted no later than 30 days after last dated services.
Patient payment to dentist is not valid for late claim submission.
Dentist must submit claim forms according to law, regardless of fee payment. If anyone is having this difficulty, let us know - we can handle it.
For Active and Retired Members
The Optical Plan covers active and retired members and their dependents in
the following ways:
- The Welfare Fund will pay up to $135.00 for the following if you go to an
optometrist:
Exam - $35.00 Lens and Frame - $100.00
Total - $135.00
The Welfare Fund will pay up to $155.00 for the following if you go to an ophthalmologist (MD):
Exam - $55.00 Lens and Frame - $100.00
Total - $155.00
Note: The member must pay any cost that exceeds the above rates.
- Tinted lenses are covered provided they are prescription lenses.
Prescription contact lenses are also covered.
- We will pay the member direct, provided they enclose a paid in full receipt with the claim form, otherwise payment will go to the doctor. Your paid in full receipt will be returned to you, if requested.
For Active & Retired Members and Dependents
The Welfare Fund will pay for Television Rentals (including color) provided that the member or dependent is confined to a hospital.
The following are eligible for this benefit:
Members
Member's Wife
Dependent Children
Retired members and their wives or widows
Please do not submit statements until the statement says, "This is the Final Bill", then turn in the statement to the Welfare Fund for payment.
The prescription plan will pay up to $75.00 per year per family towards the prescription co-payment. You must wait until July of the current year to submit for reimbursement. There is no form to fill out. Just send in $75 in receipts or a read out from your pharmacy.
For Active & Retired Members and Dependents
All members are urged to donate blood to this bank at least once a year.