Frequently Asked Questions

1. I recently got my prescription card and my dependent’s name is wrong. How do I correct this?

You can call the Fund office at (215) 561-2722 to give us the correct information, or click on ‘Contact Us’, leave us a message and someone will call you to get it corrected.

2. I will be 65 in a few months. What should I do?

It depends on your current situation – are you working or retired, do you have medical coverage or not. Refer to our ‘Retirement’ section and read ‘Getting Started with Medicare’. Call a Fund Coordinator for additional guidance if your situation warrants it.

3. I’m going on vacation and need to get my medication early?

Call the Fund at (215) 561-2722 and ask for a vacation override.

4. What prescription plan is available for my spouse when COBRA ends?

This is a complicated question which will require the assistance of a Fund Coordinator. Give us a call.

5. Can I add my stepchildren to my prescription, dental and vision coverage?

We require the birth certificate of the child and the marriage certificate verifying that there is a valid marriage between the Fund’s participant and the parent of the child along with a completed ‘Notice of Change’ card.

6. I turned in my paperwork to the Benefits department at 440, why don’t you have it?

In order to receive benefits you must submit to the School District of Philadelphia and the PFT separately.

 

7. How do I change my address or add or remove a dependent with the H&W Fund?

If you wish to change your address, or to add or delete a dependent, click on the ‘Notice of Change‘ form which outlines what documentation is required. Mail the form and documentation to the Fund, attn: Eligibility 1816 Chestnut Street Philadelphia, PA 19103.

8. What is the Family and Medical Leave Act (FMLA)?

The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave. Employers must provide an eligible* employee with up to 12 weeks of unpaid leave each year for any of the following reasons:

• for the birth and care of the newborn child of an employee;
• for placement with the employee of a child for adoption or foster care;
• to care for an immediate family member (spouse, child, or parent) with a serious health condition; or
• to take medical leave when the employee is unable to work because of a serious health condition.

If you believe you will need to apply for FMLA, the first step is determining eligibility.  Complete the FMLA Cover Sheet to find out if you are eligible.

9. How do I apply for FMLA?

The first step in the process is to complete the FMLA Cover Sheet and fax it to 215-400-4661 or email fmla@philasd.org at Employee Health Services. We encourage you to call a PFT Health and Welfare Fund coordinator for guidance and to help you apply.

 

10. I’m on wage continuation and my direct deposit keeps changing. Why?

When you are working, you get 100% of your base pay, and summer reserve is deducted and set aside for summer (RESERVE ACCR). Wage continuation pays 75% of your base pay. The payroll system may try to ‘make up’ for the difference between what you are paid when you are actively at work (100%) and when you are on wage continuation (75%).  If you see ‘RESERVE P/O’ on your paystub, instead of ‘RESERVE ACCR’, that means the system is paying you summer money in advance of summer, to try to ‘smooth’ out your earnings. Depending on when and whether you return to work during the current school year, your summer account and your paychecks are affected.

 

11. I’m having problems getting a prescription filled.  What should I do?

Please call the Fund and ask to speak to a coordinator.  We can resolve problems quickly for you.

 

12. I am a current employee. What diabetic supplies are covered under my medical coverage and what are covered under my prescription coverage?

 Medical

 Independence Blue Cross (Personal Choice or Keystone) will provide coverage for diabetic equipment and supplies purchased from a Durable Medical Equipment Provider. Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses. Co-pays will apply.

 

Equipment includes:

• Blood glucose monitors;
• Insulin pumps;
• Insulin infusion devices; and
• Orthotics and podiatric appliances for the prevention of complications associated with diabetes.

Supplies include:

• Blood testing strips;
• Lancets and lancet devices;
• Visual reading and urine test strips;

To find a provider under your Personal Choice or Keystone coverage, click here. Type in ‘Durable Medical Equipment’ in the search bar. McKesson is a known reliable supplier and they can be reached at 855-564-1161. To speak with an available Health Coach 24/7, call 1-800-ASK-BLUE (1-800-275-2583) (TTY: 711).*

Prescription

The Health and Welfare Fund benefit includes:

• Insulin:
• Needles and syringes

 13. What should I do? I need an Epi-Pen (or another type of injectable medication):

Most Injectable medications are covered under your PFT CapitalRx prescription plan. Please call the help desk at 1.877.472.2779 to see if your injectable medication is covered and as always, you may call the Fund to ask for a Coordinator if you need assistance.