This following services are available for all current and future retirees. Please save the following and use as a reference for any problems that may arise.

Notification of Death of a Retired Firefighter
Reimbursement for Medicare Part "B"
Notification of Change in Status
Health or Dental Plan Change
Summary of Retired Security Benefit Fund Benefits

Notification of Death of a Retired Firefighter

Notification of a retired firefighter's death is made to the NYC Fire Department by calling 718-999-2320 or 718-999-2321. Retirees have a life insurance policy in the amount of $5,800 with the FDNY Life Insurance Fund. This is the $9 deduction on your earnings statement listed as Fire Life.

Members who have retired after January 1, 1971 have a death benefit with the Security Benefit Fund (SBF) in the following amounts:

A claim for this benefit will be sent to your beneficiary when we receive notification of death.

Reimbursement for Medicare Part "B"

If you are receiving a City pension check and both you and your spouse are enrolled in a City health plan, you will be reimbursed for your Medicare part 'B" by the City of New York. You should send the following information to Employee Health Benefits. Make a copy of your Medicare card to show that you have both parts "A" and "B" and include the following information:

• Birth dates for you and your spouse
• Your retirement date
• Your pension number
• Name of your health plan
• Name of your union

Send this information to:
Office of Labor Relations
Employee Health Benefits Program
40 Rector Street, 3rd Floor
New York, NY 10006
Attn: Medicare Division

If you are in an HMO (Example HIP, AETNA, etc.) you must inform your health carrier that you are going on Medicare due to forms that need to be filled out with your health provider.

Notification of Change in Status

The Security Benefit Fund must be informed of any changes in your status. For example:

• When you get married, we need a copy of the marriage certificate
• When you become a new parent, we need a copy of the birth certificate
• If you get divorced, we need a copy of the first and last pages of the divorce decree
• When a spouse dies, we need a copy of the death certificate
• When you move, please update your address with the SBF

To change your address with the NYC Fire Department or to make changes for direct deposit please call pension and payroll at 718-999-2327.

Changing Health or Dental Plans

Changing Health Plans
You can change health plans every other year during the even numbered years (2004, 2006, 2008, etc). The normal time to change is in November or December in order to take effect the following January. You may also change plans at anytime if you move out of your health plan service area. A change can occur outside the normal change period "once in a lifetime." If this option is used, you can only change during the allotted change-over period, or if you move out of your service area.

Changing Dental Plans
You may change dental plans each year between October 15th and December 15th. Most plan changes take effect on January 1st. James Dahl is available Monday, Wednesday and Friday 9am – 4pm. He can be reached at 212-683-4723, Ext. 5977.

Correction: The wallet cards recently sent to retirees incorrectly list General Prescription as the drug carrier. The correct plan is PharmaCare, formerly EHS. They can be reached at 866-832-0563. Additionally, the correct phone number for the SBF is 212-683-4723.

Summary of Retired Security Benefit Fund Benefits

Eligibility
Retired firefighters and fire marshals, who retired on or after January 1, 1971 (July 9, 1993 for wipers), and their eligible dependents, including duly registered domestic partners and their dependents.

U.F.A. Self Insured Healthplex
Retiree is reimbursed in accordance with the RSBF Schedule of Fees; a dental form must be filled out. $1,500.00 limitation per family member per 12 month period. Orthodontic services for dependents under 19 years of age only.

Dentcare Program
A pre-paid comprehensive dental program that provides the necessary dental care, including orthodontics at no cost to the member, except for elective general anesthesia, porcelain crown, porcelain w/metal or pontic - $50.00. Orthodontic services for dependents under 19 years of age only. Members must select a dentist from the Dentcare panel of dentists. Cosmetic dental treatment not covered.

American Dental
Effective January 1, 1995, retirees residing in Florida may elect coverage by the American Dental Plan (ADP), a Preferred Provider Plan with most routine and preventive care provided at no charge after payment of a $5.00 routine office visit fee. A defined schedule of reduced fees applies for other general dental services. Participating ADP specialist's charge 25% below usual fees.

Optical
One eye exam and either one pair single vision, bifocal or contact lenses (subject to providers' surcharges) for retirees and eligible dependents every two years through optical provider panel. Effective January 1, 1999, maximum of $60.00 ($15-exam, $20-frame, $25-lenses, $45-contact lenses) reimbursed to retiree if other than provider(s) is used.

Death Benefit
Only the retiree is covered for this benefit. Insured through the AIG Life Companies. Payment is made to the designated primary or contingent beneficiary of an eligible deceased retiree upon submission of a completed claim form with certified death certificate. Effective April 1, 1997, coverage based upon age is:

Hearing Aid
Effective January 1,1999, retiree is reimbursed up to $600 toward hearing aid (s) purchased in a five-year period upon referral of a physician or audiologist. Send the paid bill, a copy of the prescription and a copy of the audiologist report to the RFSBF for reimbursement.

Prescription Plan
Plan administered by PharmaCare (formerly Eckerd Health Services) effective September 1, 2004. Insulin (including oral agents) and diabetes equipment and supplies are covered by all city health plans (non-Medicare). Medicare members are covered under PharmaCare. Up front annual family deductible is $125.

Participating Pharmacy
Once this deductible is met you will pay 35% of the cost of the drug or a minimum $5 generic/ $20 brand name. Retirees can obtain up to a 30-day supply at a participating pharmacy.

Non-Participating Pharmacy
Retirees using non-participating pharmacies can obtain up to a 30-day supply and may be reimbursed up to average wholesale price + dispensing fee, minus co-pay. Up-front annual deductible of $125 must be met first before co-pays apply. Reimbursement claim forms can be obtained by calling PharmaCare at 866-832-0563.

ANNUAL FAMILY DRUG CAP - $5,000. MAINTENANCE DRUGS MAIL ORDER
If you or an eligible family member regularly takes medication for chronic long-term conditions, such as arthritis, high blood pressure, heart conditions, etc., you may receive up to a 90-day supply of maintenance medication through EHS mail service pharmacy.

Note: No deductible will be required for prescriptions being filled at mail service. 35% of the cost of the drug still applies to mail order. Deductible still applies to retail prescriptions.

Pica
Plan administered by NPA. If you have any questions contact NPA's Customer Service Department at 800-467-2006, sponsor number 2020.

Effective July 1st 2005, Most injectable and chemotherapy medications will continue to be covered under PICA (non-Medicare). Most asthma and psychotropic drugs will be transferred to the UFA Retired Security Benefit Fund Prescription Drug Plan administered by PharmaCare.

Injectable And Chemotherapy Medications

Up to a 30-dav supplv at retail pharmacy:
$10 generic
$25 preferred brand (formulary)
$45 non-preferred brand (non-formulary)*

Up to a 90-day supply at the mail order pharmacy:
$20 generic
$50 preferred brand (formulary)
$90 non-preferred (non-formulary)*

EffectiveJanuary 1st 2006, there will be an annual deductible of $100 per person for injectable and chemotherapy medications. This deductible is independent of any other deductible.

If you choose a non-preferred brand drug that has a generic equivalent you will pay the difference in cost between the non-preferred brand drug and the generic drug PLUS the non-preferred brand co-payment. (increase in co-pays: effective July 1st 2005)

Medicare members are covered under PharmaCare. Up-front deductible co-pays and annual family cap apply.

Cataract Lenses
RFSBF allows up to $75.00 towards the purchase of cataract lenses after health plan, Medicare, etc. has paid its portion. Send the paid bill and health plan's (s) explanation of Benefits (EOB) to the RFSBF office for reimbursement.

Surgical Assistance Fund
RFSBF pays the yearly dues for its eligible retirees.

Dependent Student 19-23 Years Of Age
Dependent full-time students covered to the end of the calendar year of the unmarried, dependent student's 23rd birthday or until graduation, whichever occurs first. Student verification must be on file every semester.

Handicapped Dependents
Retiree must notify basic health carrier when dependents become mentally or physically handicapped, prior to 19 yrs of age. Dependent must be unmarried, living at home and dependent upon retiree for support. Upon receipt of the health carrier's confirmation that the dependent is handicapped, RFSBF coverage will be continued while the criteria are met.

Vested Retirees
Vested retirees may enroll in the RFSBF to cover themselves and their eligible dependents for the following benefits upon payment of the City's contractual contribution (5/31/02 = $1,475): Death Benefit, Dental, Prescription, Optical, Cataract, and Hearing Aid benefits. Coverage does not include the City's health plans. In all cases where there is a change of family status, member must file an ERB and forward it to:

For Medicare questions call or write:
Employee Health Benefits Program
40 Rector Street 3rd Floor
New York, NY 10006
212-513-0470

Widows' Benefits
The Retired Security Benefits Fund provides benefits for widows and eligible dependents of retired firefighters, who retired after January 1, 1971 (July 9, 1993 for wipers) and who become widowed after July 1, 1987. This group will be entitled to the same health plan and benefits under the RFSBF for a period of one year only. The trustees of the fund reserve the right to modify or discontinue the benefits of the fund at any time. Notification of changes in the benefits or procedures will be sent to your address as listed on the fund records.