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 complication 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?

Members may add stepchildren if the child is claimed as an exemption on the member’s tax return. A completed ‘Notice of Change’ card, along with a notarized copy of the tax return is required and must be submitted to the Fund.

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

The School District of Philadelphia and the PFT are separate and distinct entities.

 

7. How do I get my paperwork to the H&W Fund?

If you want to make a change, like 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.

9. How do I apply for FMLA?

We encourage you to call a 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 (RSVAC). 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 ‘RSVPO’ on your paystub, instead of ‘RSVAC’, 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.  Call and speak to a Health and Welfare coordinator for more information.

 

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. Or send a detailed email via the ‘Contact Us’ link.

 

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.

Prescription

The Health and Welfare Fund benefit includes:

  • Insulin and insulin-like products:
  • Needles and syringes

13. What do I need to know if I am expecting a baby and plan to take maternity leave?

Maternity leave is granted for six weeks after a normal delivery and eight weeks after a Cesarean “C” section, starting the day you deliver. Maternity leave is a paid leave if you have personal illness days in your bank and/or the wage continuation benefit.

Notify Employee Health Services by calling (215) 400-4660. They will send you a procedure letter which will tell you step-by-step what you need to do to take maternity leave.

If you want to take additional time after your maternity leave expires, you have the option of taking up to eighty-nine (89) calendar days of unpaid parental leave.  During those 89 days, you are still covered by the SDP medical and Health and Welfare Fund and you will maintain your position at your location.

The parent who is not giving birth only has the option to take an 89 day leave. This leave is unpaid but continues medical benefits. This is called Parental Leave.

You have the right under the Family Medical Leave Act (FMLA) for up to 12 weeks of leave in a 12-month period, if you have worked 1,250 hours during the 12 months prior to the date of your request.  Not everyone completes an FMLA application; it isn’t a requirement for a maternity leave, but a job protection in case of intermittent absences due to a medical severity. FMLA runs concurrently with an approved school district leave. What does this mean? It means if you have available paid leave (sick days or wage continuation) you will be paid for your time not working. If you have no available leave time, you have the right, if you meet the qualifications, to take the FMLA leave, but it is unpaid.

During this time, it is your responsibility to notify your location or supervisor of your absence, please follow the proper call out procedures for your location.  You can contact Kelly Services directly to help put your absence into the AESOP system at (855) 535-5955. When entering your absence into the AESOP system, use an 04 coding and enter the entire estimated length of time you think you will be absent. Payroll will not deduct sick days from your bank unless you have been authorized to use them by EHS.

You must submit absence cards (SEH-3) signed by your physician while you are out on sick/maternity leave.  One card must be filled out and submitted for each ten (10) day period of absence.  Absence cards do not need to be submitted while on parental leave because that time is unpaid.

Be sure to notify the SDP Benefits Department and the Health and Welfare Fund office within thirty (30) days of the birth to add the baby to your coverage.

Basic Vision for Active Employees

1. Do I need a form or a card?

Yes, if you are using the ‘basic’ coverage, you need to obtain a Basic Reimbursement form from your Building Rep or by calling the Health and Welfare department at (215) 561-2722.

2. How often can I have an exam?

Once every calendar year.

3. How often can I purchase glasses?

Once every 2 years calendar years unless there is a .5 diopter change in your prescription.

NVA Vision for Active Employees

1. Do I need a form or a card?

No, the NVA program has gone paperless. Simply tell your participating provider that you are using NVA under the Philadelphia Federation of Teachers.

2. What is my NVA ID #?

Your NVA ID# is your Social Security Number.

3. How often can I have an exam?

Once every calendar year.

4. How often can I purchase glasses?

Once every 2 years calendar years unless there is a .5 diopter change in your prescription.

5. Where can I find a list of participating NVA providers?

Click here for a list of providers, or you can obtain a booklet from your Building Rep or by calling the Health and Welfare department at (215) 561-2722.

 

Keystone Vision Benefit

Members who have Keystone medical coverage have a Vision-Rider benefit administered by Davis Vision.  To find a Davis Vision provider, click here.

Dental

1. My child needs braces. How does the process work?

The lifetime service dollar maximum is $1,200.00 per member and eligible dependents and applies to all orthodontic services. The initial payment will be the equivalent of 25% of our liability. The remaining balance will be paid in quarterly increments, throughout the course of active orthodontic treatment.