FAQs

1. How do I order a new medical card?

To order a new medical card, please call 1-800-ASK-BLUE or register an account at IBXpress. Contact Payroll, payrollhelp@philasd.org to update your address with the District.

2. I have an appointment with LabCorp and they are asking for my credit card information. Is this correct?

LabCorp reserves the right as a provider to request credit card information before your scheduled services. If you are enrolled in a Personal Choice plan, you can use an in-network laboratory services provider of your choosing. Please contact 1-800-ASK-BLUE to find another provider. If you are a Keystone member, you must use the laboratory services your primary care physician refers you to.

3. Can I remove my spouse from my medical coverage outside of the annual Open Enrollment?

You are required to contact the Benefits Office if you are no longer married to your spouse or if your spouse or dependent passes away regardless of the event date. Failure to remove an ineligible dependent in a timely manner may result in charges for premiums and claims incurred by the ineligible dependent.

The only other times he/she can be removed outside of the annual Open Enrollment in May are within 30 days of  the following:

  • Enrolled in alternative coverage
  • Eligible for Medicare

Within 30 days of the date of your notice of any of the above qualifying events, complete and submit:

1. A SDP Health Application and Attestation.

2. Proof of the qualifying event (i.e. divorce decree, Medicare eligibility letter, etc.)
If all required documents are submitted within 30 days, coverage for the dependent spouse will terminate the first day of the following month. For example, if a divorce is effective December 12, termination of coverage will be effective January 1.

4. My dependent (spouse or child) lost alternative coverage. How do I add them to my School District of Philadelphia coverage?

Within 30 days of an eligible dependent’s loss of coverage, you will need to complete and submit:

  • SDP Health Application and Attestation
  • Proof of loss of coverage
  • Dependent eligibility documentation (e.g. Marriage Certificate or Birth Certificate)
  • If you are CASA, Non-Represented, SPAP or PFT member and have a spouse or partner enrolled in your medical coverage, you must complete  page 2, Letter of Attestation, for any requested change.

See below for instructions. Medical Coverage: Medical Insurance Application

  • Complete section 1
  • Complete section 2, checking off “Qualifying Life Event” under Application Type, and “Add spouse/dependents” under Request Type.
  • Complete section 3 selecting the coverage in which you are currently enrolled.
  • Complete section 4 listing just the dependent(s) you are adding.
  • Sign and Date section 5
  • If you are CASA, Non-Represented, SPAP or PFT member and have a spouse or partner enrolled in your medical coverage, you must complete  page 2, Letter of Attestation, for any requested change.

Please fax 215-400-4631, or email benefits@philasd.org, or  bring in (please see Office Hours before visiting Employee Benefits), or mail all the required documents listed above. Please call (215) 400-4630 to confirm receipt if submitting by mail or fax. Prescription, Vision and Dental Coverage: Employees who are Non Represented, CASA, and SPAP – your dependent will be added to these coverages provided you have completed the paperwork for medical coverage above. If your position is represented by PFT, Local 634 or District 1201 – please contact your Union’s Health & Welfare Office to add your dependent to your Prescription, Vision, and Dental coverage.

5. I’m insulin dependent. How do I go about getting my prescriptions and supplies?

Typically insulin is dispensed at your pharmacy. Other supplies may be covered by your medical insurance.  Check out our Diabetic Supplies page.

6. How do I submit for Vision reimbursement?

CASA, Non-Represented, and SPAP represented employee  enrolled in vision coverage  should complete and mail the Direct Reimbursement Claim Form with receipts attached to: Vision Care Processing Unit P. O. Box 1525 Latham, NY 12110 To obtain a claim form, please visit https://www.ibx.com/sdp/forms.html .

7. What is my Vision benefit?

All Keystone members may visit the eye doctor. Specialist co-pay applies. Personal Choice members with a combined Medical and Prescription ID card (CASA, SPAP and Non-Represented employees) are eligible for an eye exam, including refraction and glaucoma screening, and dilation, as professionally indicated with no copay at participating providers. No referral needed. Those eligible for the vision exam as noted above, also have a Biennial Benefit (every other year) for Eyeglasses reimbursement. Using a Davis Vision Network will maximize the eyeglasses benefit. A reimbursement of up to $100 is available for contact lenses and glasses from a non-network provider. You can check your eligibility for this reimbursement from https://www.ibx.com the portal by clicking the “manage your vision benefits” link or by contacting Davis Vision at the number on the reverse of your insurance ID Card. Employees represented by Local 634 and PFT should contact their union for vision reimbursement information.

8. How do I update my Primary Care Provider ?

You can update your Primary Care Provider (PCP) by contacting Independence Blue Cross at 1-800-ASK- BLUE (1-800-275-2583) or online by creating an IBC account at www.ibxpress.com.

9. What is the difference between Keystone HMO, Personal Choice 20/30/70%, and Modified Personal Choice 320?

Our Keystone HMO and Personal Choice plans cover basically the same services, with the exception of infertility which is only covered through Personal Choice. The difference in the plans is how and where you access services and your co pays and co-insurance. Below are the general differences between our Keystone and Personal Choice plans: For In-network providers, Keystone offers Co-pays of $20 for primary care providers and $30 for specialists, Personal Choice 25/35 co-pays are $25 for primary care providers and $35 for specialists. Keystone HMO requires a referral from your primary care physician for all specialty care. For Keystone, you must use network providers and some services are capitated, meaning you must use specific therapy centers, labs or other facilities, etc. There is no out of network benefit for Keystone. You are responsible for any out-of network charges and non emergency services provided without a referral.

Personal Choice 25/30/70% services provided by an out-of-network provider or facility are covered at 70% of the reasonable and customary amount after a $500 individual or $1,000 family deductible is met. Your co-insurance is 30%. If the providers’ charges are greater than the reasonable and customary amount, they may balance bill you for any remaining amounts. Modified Personal Choice 320 services provided by an out-of-network provider or facility are covered at 70% of the reasonable and customary amount after a $750 individual or $2,250 family deductible is met. Your co-insurance is 30%. If the providers’ charges are greater than the reasonable and customary amount, they may balance bill you for any remaining amounts. This plan is only offered to Non-represented and CASA union employees.

10. I have Keystone HMO, how do I change to Personal Choice?

Eligible employees represented by PFT and SPAP, who have completed 4 years of service as specified in the applicable collective bargaining agreement, may complete and submit an enrollment form to the Employee Benefits office.  Applications received by the 15th of the month will be processed for the first of next month. Applications received after the 15th of the month will be processed for the first of the succeeding month. Applicable premium contributions will be deducted from bi-weekly pay.

11. Can I get a Shingles shot?

The shingles shot is covered for subscribers 60 and above. Member can have shingles done at doctor’s office and billed to insurance. If doctor does not stock vaccine, it should be requested through direct ship for member.

12. How do I get an injectable drug filled?

Employees with a combined Medical and Prescription card from Independence Blue Cross can visit their pharmacy or use FutureScripts mail order service. Member Services can be reached at (888) 678-7012 for assistance.

Employees with PFT  or Local 634 prescription coverage who need an injectable prescription OTHER than insulin, need to have the prescription filled by the Direct Ship Program through their medical coverage. Employees can give their provider the appropriate Direct Shipment form available on the Forms page or have the PROVIDERS contact the Direct Ship Program at 267-402-1711 or 888-678-7012. The provider faxes the completed form to 215-761-9165. The Direct Ship Program reviews and approves or denies request – the doctor is faxed back the decision. Employees may contact the Direct Ship Program at 1-800-275-2583 if further assistance is needed.

13. How do I change the beneficiary of my SDP Life insurance?

To update the beneficiary of your SDP Basic $2,000, $25,000 or $45,000 or retiree $2,000 policy, you must complete and return the “Designation of Beneficiary” form on the forms section of the benefits website. Submission of this form will replace your current beneficiaries. If no beneficiary has been designated for a policy, proceeds will be disbursed to your next of kin. You must contact PSERS directly to update beneficiary information for your pension.

14. How can I add my grandchild to my coverage?

You can add a grandchild to your medical coverage only if you have legal custody. You must provide custody papers within 30 days of the court order and complete an enrollment application. Otherwise, your grandchild can only be added during our annual open enrollment in May, which is effective July 1 and legal custody papers will be required. However, if a dependent currently enrolled on your coverage, gives birth, that grandchild is covered as specified by PA ACT 81 , which states: “The newborn child(ren) of you or your Dependent shall be entitled to the benefits provided by the Plan from the date of birth. To add a newborn grandchild to your coverage, you must notify the group within 30 days of the birth”.  You must contact benefits@philasd.org or 215-400-4630 to enroll a newborn grandchild under Act 81.

15. How long may my children remain on my Medical coverage?

Once enrolled, your eligible children remain on your district paid benefits until the end of the month they turn 26. They can be removed from your coverage during our annual open enrollment in May, effective July 1, or during the year if they experience a qualifying event, new coverage from another source, marriage, etc. Foster children and children added by court custody documents are covered until age 18 or additional eligibility is provided. You will receive enrollment materials for self-pay benefits from our Third Party Administrator, Discovery Benefits, for continuation of coverage when dependent’s coverage expires.

16. How do I cancel my Wage Continuation?

PFT, CASA, SPAP, 1201/32 BJ, Non-represented and Local 634 employees are only permitted to cancel participation during the annual Open Enrollment held in May for a July 1 effective date.

17. How do I apply for PSERS Premium Assistance?

If you are electing an HOP Medicare plan, Contact the Health Options Program (HOP) at 1-800-773-7725.  Retirees enrolling in District sponsored Keystone or Personal Choice or 32BJ Keystone POS coverage and also meeting PSERS Premium Assistance eligibility guidelines may be eligible for Premium Assistance. If you open an account on PSERS Member Self-Service (MSS) Portal, and elect PAPERLESS DELIVERY, your Premium Assistance election form be sent to your account on the PORTAL and you will receive an email from PSERS stating there is a document for you to view or print. If you opt out of the PAPERLESS DELIVERY, you will receive a 2-side original Application via the USPS mail.

You should should sign and date Section D, Member CertificationEmployee Benefits staff will complete Sections B and C,  Plan Information and Employer Information one enrollment and payment are confirmed.

Retirees may bring forms to the Office of employee Benefits during Walk-in Customer Service Hours or mail the original, signed form to Employee Benefits, 440 N. Broad St, Suite G-10, Philadelphia, PA 19130.  Completed forms will be mailed to PSERS and a copy returned to the retiree.

18. Am I eligible to continue my coverage until age 65?

Retirees and their spouses who meet at least one of these conditions are eligible to continue their self-paid coverage’s through the SDP until they are eligible for Medicare, typically age 65.

  • took normal retirement, also known as superannuation retirement as defined by your PSERS Class*, or
  • retired with 30 or more years of service, OR
  • were receiving PSERS disability benefits.

Years of service are based on their PSERS service credit. If you believe you are eligible and this is not reflected in your continuation account, Contact the benefits department to review your status.

*Normal Retirement

CLASS Requirements

Class T-C and Class T-D

 

You are age 62 with at least one (1) full year of credited service at the time you terminate active or inactive service.
You are age 60 and have 30 or more years of credited service.
You have at least 35 years of credited service regardless of age.
Class T-E and Class T-F You are age 65 with at least three (3) years of credited service at the time you terminate active or inactive service.
You attain at least 35 years of credited service and reach an age that in combination is equal to or greater than 92 (for example, 36 years of service plus age 56 equals 92).

19. How do I change my name?

Complete the Name Change Request along with supporting documentation (marriage certificate, photocopy of Driver’s License or Birth Certificate). This can be sent to benefits@philasd.org or by fax to 215-400-4631. This form will change your name for the School District Systems, Medical Insurance (if applicable), and the PSERS pension plan. You must contact your Union directly.

20. How do I change my address?

Address changes must be submitted to the Payroll office via an “EMPLOYEE CHANGE OF RESIDENTIAL ADDRESS“, which is available on Payroll website. The form must be accompanied by a copy of the employee’s School District photo ID, or other government issued photo ID. It may be mailed or fax directly to the Payroll Department at (215) 400-4491.This form will change your address for the School District System, Medical Insurance (if applicable), and the PSERS pension plan. You must contact your Union directly.

21. How do I add my Spouse to my coverage?

Within 30 days of the marriage, complete pages 1 and 2 of the enrollment application and return to our office with a copy of the marriage certificate.

This application is used for all Medical plans.

  • Fax application and a copy of marriage certificate to the Benefits Office at (215) 400-4631 or email to benefits@philasd.org. Call (215) 400-4630 to confirm receipt of the application and marriage certificate if submitting by fax.

Prescription, Vision and Dental Coverage:

  • Employees who are Non Represented, CASA, and SPAP – your spouse will be added to these coverages provided you have completed the paperwork for medical coverage above.
  • If your position is represented by PFT, Local 634 – please contact your Union’s Health & Welfare Office to add your spouse to these coverages.
  • District 1201/32 BJ must contact their national union at 877-605-8300 for medical coverage and their local at 215-627-9720 for prescription, dental and vision benefits.

22. How do I add my newborn to my coverage?

Within 30 days of the birth, complete the enrollment application and return to our office with a copy of the hospital birth record.

  • SDP Health Application and Attestation
  • This application is for all SDP provided insurance plans
  • Complete all sections in entirety.
  • Fax application and a copy of hospital birth record to the Benefits Office at (215) 400-4631 or email to benefits@philasd.org. Call (215) 400-4630 to confirm receipt of the application and hospital records.
  • If you are CASA, Non-Represented, SPAP or PFT member and have a spouse or partner enrolled in your medical coverage, you must complete page 2, Letter of Attestation, for any requested change.

Within 60 days from date of birth – Fax a copy of the child’s birth certificate and Social Security Number Office at (215) 400-4631 or email to benefits@philasd.org. Call (215) 400-4630 to confirm receipt if submitting by fax.

Prescription, Vision and Dental Coverage:

  • Employees who are Non Represented, CASA, and SPAP – your newborn will be added to these coverage provided you have completed the paperwork for medical coverage above.
  • If your position is represented by PFT, Local 634 or District 1201 – please contact your Union’s Health & Welfare Office to add your newborn to these coverages.

23. Where do I make my COBRA payment?

Discovery Benefits, an independent company, will bill you and collect premiums for your COBRA-related health insurance.Once you have elected to enroll in COBRA coverage, you will receive monthly premium payment coupons from Discovery Benefits. All election materials and payments are made directly to Discovery Benefits. You may contact Discovery Benefits at (866) 451-3390 about your monthly premium payment coupons. You may also email the Discovery Benefits at cobradmin@discoverybenefits.com.

24. When and how can I enroll or re-enroll in the Aetna Term Life Insurance program?

New participants: Employees select a plan, complete a Designation of Beneficiary at time of hire. These forms are supplied to the employee by the Employee Benefits staff. The effective dates of your plan may vary. See your Union’s contract for any applicable probationary period that may delay the effective date of your coverage. There is a 31 day enrollment period from an employee’s date of hire. If the employee elects Basic Term Life Insurance after the initial enrollment period, an Evidence Of Insurability must be completed and submitted to the Employee Benefits Office. The completed form will be forwarded to he Aetna Life Insurance Company for final approval.

25. How do I obtain a Certificate of Group Coverage for my life insurance policy?

Group policy information for The Aetna Life Insurance plan(s) is available by contacting Benefits (215) 400-4630. If you are entitled to a retiree policy, a summary sheet with contact information will be mailed to you within 90 days of your retirement.

26. When and how can I make changes to my life insurance enrollment?

Making changes to your enrollment: Employees can cancel enrollment or apply for the policy for the Basic Term Life Insurance at any time. Enrollment requested after the initial 31 day enrollment period will require completion of the Evidence Of Insurability and approval from The Aetna Life Insurance Company. Coverage is not guaranteed.
Employees can change the beneficiaries at any time. Complete the Designation of Beneficiary and submit the original form to the Employee Benefits Office at 440 N. Broad Street, Suite G-10. The employee should keep a copy for their records. Faxed or scanned designation of beneficiary forms will not be be accepted.

27. Who do I contact if I am interested in taking a sabbatical?

For 10 year professional development or 20 year sabbaticals or educational leaves, contact Employee Records at 215-400-4600 Option 7 or employeerecords@philasd.org.

For restoration to health sabbatical, contact Employee Health Services at 215-400-4660 or employeehealth@philasd.org.

28. What do I do if I do not have prescription coverage?

If you are not eligible for prescription coverage based on your position or if you need a prescription before your prescription insurance is effective, you can use GoodRx to find discounts and the best price for your medication. This is available to all employees and dependents. More information is available at GoodRx_flyer_v1.