Philadelphia Federation of Teachers (PFT) represented Benefits

The options administered by the School District, are explained below.

Prescription, Dental and Vision benefits:

Your PFT Health and Welfare Fund provides Prescription, Vision, Dental and Legal benefits.  The plans administered by the School District, are explained below.

Support Service Assistants (SSAs) are not eligible for Medical and Wage Continuation coverage, but are eligible for PFT health and welfare benefits and the term life insurance policy of either $2,000 or $25,000.

Medical Insurance

The School District of Philadelphia offers new employees represented by the PFT Keystone HMO and  for those meeting service requirements, they may elect Personal Choice* coverage. These plans are provided by Independence Blue Cross(IBC).  If you begin full-time work by the 15th calendar day of the month, medical coverage becomes effective on the 1st of the following month. If you begin after the 15th, coverage becomes effective on the 1st day of the next succeeding month.

For downloadable medical forms, please see below.

Summary of Benefits

• • Keystone HMO 20
  • PFT PC 25 35 50*

*Requires 4 years of current PFT service.

Medical Forms- 

• SDP-Health-Application and Attestation
• This application is for all SDP provided medical plans to all employees. Only complete this if you are reporting a qualifying life event.  New hires should complete the google form at https://www.philasd.org/benefits/home/on-boarding-for-benefits/
• Complete all sections in entirety.
  • Please refer to General Documentation Required section for a list of documents that may need to accompany your completed application
  • The completed application and documentation, if required, can be faxed in to the Benefits Office at (215) 400-4631 or emailed to benefits@philasd.org.
  • Please call (215) 400-4630 to confirm receipt if submitting by fax.

PersonalChoiceOutofNetwork Claim Form

Request to Remove Spouse or Dependent

Employees enrolled in Medical Coverage, Keystone or Personal Choice, will see a deduction of 1.5% of  gross salary, labeled “SLRY MED DED”. The spousal surcharge and any Personal Choice premiums will be on a separate line labeled “MED BENE”.

PLAN OPTIONS

As an employee newly represented by PFT, you may enroll in Keystone HMO 20. After four (4) years of eligible service, you are eligible to elect the Personal Choice 25-35-50 which carries an additional premium.

Premium Co Share

All employees enrolled in medical coverage contribute 1.5%  of salary for medical insurance. Additional charges may apply for spousal coverage and electing Personal Choice coverage. The sections below outline the bi-weekly premiums employees and the medical tier in which they are enrolled. Deductions are on a bi-weekly basis; the deductions occurs on every paycheck throughout the year. Deductions are made on a pre-tax basis. Philadelphia Federation of Teachers (PFT) who have completed four years of full time service are eligible to switch from Keystone Health Plan East to Personal Choice. A 5% Premium Co-share applies.

You may see two deductions on your pay check.

• You will see a deduction that is 1.5% of salary labeled “SLRY MED DED”
• You may have an additional charge if you elected Personal Choice or if you are subject to the spousal surcharge*.  This premium will be labeled “MED BENE”.
• Rates are effective as of July 1 through June 30.

Rates below are for PFT represented employees.
New premium increases are effective in the July 1, 2023 pay.
Tier Level	Keystone 20	Personal Choice 25/35/50%.	Personal Choice 25/35/50%.	Personal Choice 25/35/50%
	PFT 1.5% Salary	0 % premium + 1.5% Salary. Closed to new enrollment.	3 % premium+1.5% Salary. Closed to new enrollment.	5 % premium +1.5% Salary.
Single	$0	$0	$9.27	$15.45
Employee & Child	$0	$0	$12.97	$21.63
Employee & Children	$0	$0	$16.68	$27.81
Employee & Spouse or Life partner	$0	$0	$18.54	$30.90
Family	$0	$0	$27.80	$46.34
Employee & Spouse or Life partner with Surcharge	$34.62	$34.62	$53.15	$65.51
Family with Spouse or Life Partner Surcharge	$34.62	$34.62	$62.42	$80.96

Your salary contribution payroll deduction is spread over all 26 pays of the year. You can calculate the per pay cost by taking your annual salary, multiplying by 1.5% (0.015) and then dividing by 26.

*Spousal surcharge: Employees covering a spouse or domestic partner on their Medical coverage will be required to sign an Attestation of Spousal/Domestic Partner Form verifying his/her spouse or same-sex life partner does not qualify for other employer health coverage in order to waive the surcharge. If your spouse/domestic partner qualifies for employer health coverage, you will be subject to the surcharge of $75 per month. To provide a consistent deduction on your check, the spousal surcharge is spread over all 26 pays. The form is available on page 2 of the SDP-Health-Application and Attestation.

General Documents Required

If you are adding a dependent to your coverage, you must provide documentation.  Refer to the chart below.  In most instances, you will have to provide at least two documents per dependent. Residential address must match address of record of employee. All documents must received within 30 days of your date of hire or qualifying life event in order to be processed. Address changes are handled by the Payroll Department at (215) 400-4490 or payrollhelp@philasd.org.

To cover a:	You must provide:
Spouse	Marriage Certificate AND ONE of the following: Current* mortgage statement, home equity loan, or lease agreement Current* Property Tax documents Automobile registration that is currently in effect Current* credit card or account statement Current* utility bill in spouse’s name Current* designation as the primary beneficiary for life insurance(not SDP sponsored life insurance) or retirement benefits, or primary beneficiary designation under an employee’s will Assignment of a durable property power of attorney or health care power of attorney Valid government-issued ID with address matching employee address of record Page 1 and signature page of employee’s most recent Federal Income Tax Return (1040, 1040A or 1040EZ) as filed with the IRS listing the spouse Page 1 and certificate of filing or email confirmation of electronic submission of employee’s Federal Income tax Return (within two years)(1040, 1040A, or 1040EZ) as filed with the IRS listing the spouse *Current is less than 1 year old.
Same Gender Domestic	Partner Commission on Human Relations letter from the City of Philadelphia or comparable official document AND ONE of the secondary documents listed above in the “SPOUSE” section.
Child under the age of 26	Birth Certificate and social security number. Proof of dependency may be required. Acceptable proofs of dependency for children differ depending on the relationship between the child and the employee (and in some cases, the employee’s marital status).
Disabled child, age 26 or older	Birth Certificate, social security number and Certification by the insurance carrier as an individual with a disability.
Stepchild under the age of 26	Marriage certificate indicating stepchild’s biological parent is married to the employee, birth certificate listing spouse as parent and divorce decree indicating spouse is primary care giver or a signed statement attesting to financial responsibility.

Wage Continuation

Wage Continuation is the School District of Philadelphia’s (SDP) salary continuation program. You may elect coverage to protect yourself from sustained salary loss due to an illness or non-work related injury that extends beyond your sick time. If you are not enrolled in Wage Continuation and are out due to an illness or non-work that extends beyond available paid sick leave, you will be unpaid and your health benefits will end after 89 days of unpaid leave.

Should you become ill and exhaust all accumulated sick leave, at the conclusion of a short waiting period (0-7 days), you will be compensated a daily amount consistent with 75 percent of your salary for up to 26 weeks, pursuant to SDP approval.

In order to qualify for the continued salary benefit, you must be enrolled in the program prior to the injury or illness and your absence will be monitored by Employee Health Services. Enrollment in the Wage Continuation program does not guarantee eligibility of use. You must be approved by the Health Services Department for use of this program.

Who is eligible for this benefit?

This benefit is extended to all salaried or benefits eligible employees, as outlined in the Collective Bargaining Agreement.

When and how can I enroll?

New employees may enroll at the beginning of SDP service; however, you will not be eligible for the program until after five (5) months of qualified service, at which time your premium contributions will begin to be deducted from your pay.

• New PFT employees can enroll during the first year of service, but must be actively at work in order to be approved for Wage Continuation.
• Existing employees (after the first 12 months of service) can enroll or cancel coverage only during the Annual Open Enrollment.
• To enroll, eligible employees must complete the application and send it to benefits@philasd.org. The application can only be accepted during Open Enrollment or during the first year of PFT service. Employees must be actively at work to be approved for coverage.

Before completing the form, we suggest that you review the deduction examples below.  This benefit can be costly, depending on how many sick days you have in your bank. It is typically very costly for employees with small unused sick banks.

When does my coverage begin?

Coverage for new employees who enroll at the beginning of SDP service will be after the conclusion of 5 months(excluding July and August) from the hire date.  At that time, premium contributions will  be deducted from your pay.

Coverage for employees who apply during Open Enrollment will begin at the beginning of the school year when all employees are advanced Personal Illness leave for the new school year. At that time, premium contributions will be deducted from your pay.

What does the deduction look like on my paycheck and how much will I have to pay?

Premiums paid for the Wage Continuation program are non-refundable.

The cost of this indemnity program is dependent upon the amount of your accumulated sick leave, number of years of service, and salary.  There is no premium contribution if you have 60 or more  unused Personnel Illness days in your bank.  Ten month employees do not contribute to Wage Continuation during the summer break.

Contributions are evaluated at the time of enrollment and at the start of each school year. At that time, you will be placed in the appropriate plan, as detailed in the charts below. Each plan type has an associated premium and “corridor days”.

“Corridor days”, also known as annual waiting period, are the days that you are required to wait between the use of your last sick day and  when your Wage Continuation payments begin. The waiting period must be completed once each school year, and ranges from 0 to 7 work days.

What does it looks like on my paycheck?

Your paycheck includes two indicators of your enrollment in the program. Please refer to this Sample Pay Stub for an example.

There is a box labeled “H.I. PLAN” under the box that contains the “EMPLOYEE NAME”. Enrollment is indicated by a code that shows how many corridor days you have and the range of accumulated sick days which your enrollment was assessed. Here are examples of the code and what it means:

The other indicator of your enrollment is the deduction.  There is a code in the DEDUCTIONS column. That code is “WAGE CON”.

How can I cancel participation?

To cancel coverage, complete the Wage Con Cancellation form and submit during the annual open enrollment in May, effective July 1. You may only cancel coverage during the Open Enrollment period May 1 through May 31 for a July 1 effective date.

How do I use this benefit throughout the year?

Enrollment in the Wage Continuation program does not guarantee eligibility of use. You must be approved by the Health Services Department for use of this program.If you find yourself in a situation where you cannot return to work due to illness or injury (not work related), you must coordinate your absence with the Employee Health Services (EHS) department.  Completing the following steps will ensure a smooth transition:

• For absences over 3 consecutive days, submit an Extended Illness Form SEH-3  to EHS.
• You will receive a letter from EHS scheduling an appointment for you to visit the SDP’s physician for review of your absence.
• You will continue to use all accrued (banked) sick days until you have none left.
• Upon approval of your continued absence, you will have a waiting period between your last sick day and when Wage Continuation payments begin.  Waiting periods are listed above in the “How much will I have to pay”section and range between 0-7 work days, depending on which plan you are enrolled in.
• Wage Continuation payments continue until you are cleared to return to work. Payments may continue for up to 26 weeks.

You may contact Health Services at (215) 400-4660 or by e-mail at employeehealth@philasd.org Their office is located at 440 N. Broad Street, Rm 134, Philadelphia, PA 19130

How much do I have to pay?

Please review carefully.

Below are the bi-weekly rate charts and examples calculating premiums.  Important: All premiums paid for the Wage Continuation program are non-refundable.

Refer to the chart below that explains the bi-weekly rate charged for participating in the Wage Continuation Program. The bi-weekly rate is per every $100 of salary.

Note: Premiums for employees are typically high if there are a limited number of unused sick days that are accumulated.

The “quick” way to find your bi-weekly premium is by doing the following calculation:

Formula:    Biweekly Gross pay ÷ 100 × Rate from chart = Biweekly premium

*Note that the purpose of this formula and calculation is to give an approximate value of the biweekly deduction. Actual biweekly deduction amounts may vary.

Employee’s share rate per $100 gross per paycheck

The “quick” way to find your bi-weekly premium is by doing the following calculation:

Formula	Biweekly Gross pay (before taxes)	÷	100	×	Rate listed in the chart above	=	Total biweekly premium
Less than 10 days	$2,200.00	÷	100	×	$2.95	=	$64.90 per pay
10 but less than 30 days	$2,200.00	÷	100	×	$2.10	=	$46.20 per pay
30 or more days	$2,200.00	÷	100	×	$0.31	=	$6.82 per pay

Here is an example of what to expect:

There are significant differences in the premium that you pay based on the number of unused personal illness (sick) days in your bank.

Below is example based on an annual salary of $44,198 and a bi-weekly pay rate of $1,693.41 and are in your first 3 years of of PFT service:

• If you have less than 10 personal illness days in your bank, the bi-weekly deduction (each paycheck) would be $49.96 at the $2.95 rate. (i.e. $1,693.41÷100×2.95=49.96)
• If you have 10 but less than 30 personal illness days in your bank, the bi-weekly deduction would be $35.56 at the $2.10 rate. (i.e. $1,693.41÷100×2.1=35.56)
• If you have 30 or more personal illness days in your bank, the bi-weekly deduction would be $5.25 at the $0.31 rate. (i.e. $1,693.41÷100×0.31=5.25)

Life Insurance

Basic Term Life Insurance is a plan that pays your designated beneficiary (ies) a fixed payment amount in the event of your death.  The School District’s plan pays a Death Benefit only.  There is no cash value associated with the plan.  You are eligible to elect a $2,000 or $25,000 policy.  Premiums are charged in the second pay of each month.  The District pays 50% of the premium, your cost is $0.16 or $2.00 respectively.  In the event of your death in active service, your beneficiary will receive this payment amount.

Voluntary Term Life Insurance

Voluntary Term Life Insurance is an additional plan that pays your designated beneficiary (ies) a fixed payment amount in the event of your death.  You can also enroll your spouse and children in policies of their own if you participate in the plan. Call Benefit Harbor at (888) 391-3841 for general information, changes, and forms. For downloadable life insurance forms, please visit our Life Insurance page.For information on Life Insurance Eligibility / AD&D Chart (Accidental Death & Dismemberment) and Retiree Policies (BASIC TERM LIFE), visit our Life Insurance page.

PFT Legal Services Fund
215-972-0942 or www.pftls.org
The PFT Legal Services plan provides free and reduced cost legal services for members and their families, including legal advice, court representation, wills or home-purchase assistance. A legal services fund coordinator can speak at chapter meetings and provide members with information about the plan. Call the number above to set up a visit by the coordinator. Call 215-814-9200 to set up an appointment with a lawyer.

Over 65?  This information on Medicare enrollment is intended to be a guide only. You are strongly encouraged to contact Medicare at 1-800-MEDICARE to get definitive information on when you should enroll.

If you or your spouse are Medicare eligible (usually age 65 and older), and are enrolled in our active medical coverage, generally you do not have to enroll in and pay the premium for Medicare Part B. You can enroll in Medicare Part B during a Special Election Period (SEP) following you or your spouse’s retirement. Because the District is a Large Group Health Plan (LGHP), we cover more than 12,000 employees, our understanding is that for active employees and their dependents, unless they qualify for Medicare based on End Stage Renal Disease (ESRD) the District’s medical coverage is primary over Medicare so it would pay medical claims before Medicare.  As such, you have the opportunity to delay enrolling and paying for Medicare Part B until the time you separate from active service from the District.

When you separate from the District, the Benefits Office can provide a CMS L-564 Employment Verification Form to document your loss of coverage.  That should provide a Special Enrollment Period (SEP) window to enroll in Part B with no enrollment Penalty.With respect to Part A, most employees/dependents are automatically eligible and enrolled at age 65 based on their own or their spouses work history and contributions to Medicare (FICA MED).

Most people get Part A premium-free. If you didn’t enroll in Part A when you were first eligible, you can sign up when you start receiving Social Security or during the General Enrollment Period between January 1–March 31 each year.  Your coverage will start July 1.

There are several helpful publications and references on the Medicare website that should provide clarification to your questions.  You may be able to request printed copies.

Medicare and You
When can I sign up for Part A & Part B?