FAQs

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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. 32 BJ members should contact their national union at 32 BJ at 877-605-8300 or visit their website, http://www.32bjfunds.org/.

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 a dependent from my health insurance at any time?

No, you cannot remove a dependent from your health insurance at any time. You can remove a dependent from your health insurance either  within 30 days of a qualifying event, or during the open enrollment period, which happens May through May 31 for a July 1 effective date. If you are divorced more than 30 days in the past, please contact us at 215-400-4630 or benefits@philasd.org.

The following are considered qualifying events:

Change in marital status
Change in employment status of you or your spouse
Death of spouse or other dependents
Birth or adoption of a child
Dependent no longer eligible (due to age, full independence, or marriage)
A significant change in your plan costs

Enrolled in alternative coverage
Eligibility 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 Form

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.

NOTE: 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.

4. How can I elect health coverage outside of the annual Open Enrollment period?

You can only elect health coverage within 30 days of your date of hire or during the annual Open Enrollment period or if you experience an IRS qualifying event. You must notify our office within 30 days of the event. Dated proof of the event will be required.

Qualifying Life Events include:

  • Loss of alternate health coverage
  • Marriage
  • Divorce
  • Birth or adoption of a child

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 Form
  2.  Proof of the qualifying event (i.e. divorce decree, loss of health coverage letter, etc.)
  3. Submit all documentation to benefits@philasd.org or by fax to 215-400-4631. If faxing, please call 215-400-4630 to confirm receipt.

Prescription, Vision and Dental Coverage:

Employees who are Non Represented, CASA, and SPAP – you 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 these coverages.

5. I lost coverage under my spouse or another employer plan. How do I enroll in the School District of Philadelphia coverage?

Within 30 days of a loss of coverage, you will need to complete and submit:

See below for instructions.

  • 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 your coverage option.
  • Complete section 4 listing just the dependent(s) you are enrolling.
  • 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 dependents 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.

6. 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.

7. How do I submit for Vision reimbursement?

CASA, Non-Represented, and SPAP represented employees 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/htdocs/custom/sdp/index.html

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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 can now receive injectables through their pharmacy benefit.

14. 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 “Beneficiary Designation Form” 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.

15. 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.

16. 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.

17. 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. Wage Continuation cancellation forms will be made available May 1.

18. 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 will 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 Certification.  Employee Benefits staff will complete Sections B and C,  Plan Information and Employer Information once enrollment and payment are confirmed with Discovery Benefits.

Due to the pandemic, our office is closed to walk in customer service to ensure everyone’s safety. Forms can be emailed to benefits@philasd.org.

19. 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.

20. How do I change my name?

Contact benefits@philasd.org to update or correct name, suffix or pre-fix or gender. This will change your name for the School District Systems, Medical Insurance (if applicable), and the PSERS pension plan. You must contact your Union directly.

21. 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.

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

You can enroll your spouse within 30 days of marriage or a qualifying life event (QLE). Within 30 days of the marriage or QLE, complete pages 1 and 2 of the enrollment application and return to our office with a copy of the marriage certificate and supporting documents.

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.

23. 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 Form
  • 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 submitting by fax.
  • 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 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 newborn to these coverages.

24. Where do I make my COBRA payment?

WEX, formerly 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 WEX. All election materials and payments are made directly to WEX. You may contact WEX at (866) 451-3390 about your monthly premium payment coupons. You may also email the WEX Benefits at cobradmin@discoverybenefits.com.

25. When and how can I enroll or re-enroll in the Hartford (formerly Aetna) Term Life Insurance program?

New participants: Employees select a plan and complete a Beneficiary Designation Form within 31 days of date of hire.  Life insurance selection is done in the same Google enrollment form used for health coverage. 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. If you do not enroll term life insurance within 30 days of hire, you must wait until the annual Open Enrollment period.

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

Group policy information for the Hartford (formerly Aetna) Life Insurance plan(s) is available by contacting Benefits (215) 400-4630 or lifeinsurance@philasd.org. 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.

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.

29. 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 Form
  • 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.

  • 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.

30. Can my spouse be enrolled in my District health coverage without a social security number?

Our insurance carriers require a social security number for enrollment purposes and Affordable Care Act (ACT) reporting of health coverage to the IRS. If your spouse does not have social security number, we can accept an Individual Taxpayer Identification Number (ITIN).  More information on ITIN is available by the IRS at https://www.irs.gov/individuals/how-do-i-apply-for-an-itin.

Please contact the Benefits office, benefits@philasd.org for further questions or exceptions.

31. What is a Independence Blue Cross Guest Membership?

Guest memberships are available to employees and family members enrolled in the Keystone HMO plan. When you know that you or a covered member of your family will be out of the area for at least 90 days, you can apply for a guest membership with a participating HMO plan in your travel area, where available. The Away from Home Care® program offers a comprehensive set of HMO  benefits through a participating plan while away from home. More information  and detailed instructions are available at https://www.ibx.com/htdocs/custom/sdp/member-resources/guest-membership.html.

32. What are qualifying life events (QLE)?

A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the annual Open Enrollment May 1 through May 31 for a July 1 effective date.

Qualifying life events (QLE) may include loss of existing health coverage including job-based, individual, and student plans, losing eligibility for Medicare, Medicaid, or CHIP, turning 26 and losing coverage through a parent’s plan, getting married or divorced, having a baby or adopting a child, or death of an insured member.

QLEs must be submitted to our office, benefits@philasd.org, within 30 days of the event and require supporting documentation.

33. My dependent child is turning 26, but is disabled. How do I continue coverage?

If your dependent is aging off at age 26, you can can retain medical coverage through the disabled dependent enrollment process. This requires you and your dependent’s provider to complete and submit a Disabled Dependent Application.

The application and necessary documents can be mailed back or emailed to one of the addresses on the application.
Upon receipt, the application and documents will be reviewed for completeness and the details provided. The review process can take 5 – 7 business days, however depending on the circumstance the review can take more time. An applicant’s decision status is mailed to the you with one of the following:

  • Approved for life time or one year – short term enrollment;
  • Pending for more information, the letter will provide the necessary details. In some cases the Medical Review team will reach out to the Provider and attempt to obtain more information;
  • Denied and the reason why.

For the 1 year short term enrollment, annual recertification is required. 60 days prior to the dependents termination, a digital notification or letter will be sent from the medical insurance carrier. You must complete the application process and resubmit the application/documents.

 

34. I had to pay out of pocket for my flu shot. Can I be reimbursed?

Immunizations, including flu shots and COVID-19 vaccines are not covered under the prescription plans for PFT represented and Unite Here Local 634 employees. If your position is represented by one of these unions and you had to pay out of pocket at a retail pharmacy, you can submit for reimbursement through your medical plan by using the below form:

Flu Reimbursement Form from Independence