Health Benefits Phone 212-587-9120
Health Benefits Fax (212) 587-9149
All Detectives and Detectives and Detective Investigators for whom the Detectives’ Endowment Association (DEA) Health & Welfare Fund receives a contribution under Collective Bargaining Agreements with the City of New York are eligible for these benefits, provided they have retired in good standing from the Office of the District Attorney or the Special Narcotics Prosecutor.
Dental Benefits
Members have the option of choosing one of two different plans, either the Comprehensive Panel Program or the Fee Schedule Plan.
Comprehensive Panel Program: an enrollment care is needed. Members select a panel dentist whom the entire family is required to use. You must use only this dentist. There are no dental forms to submit. Enrollment for this plan is done monthly. If the application is received by the 15th of the month, it will be effective the first of the following month. Members enrolled in this plan are not permitted to use the providers under the Fee Schedule Program.
Fee Schedule Program: (download dental form) Members may choose any dentist they prefer and pay the dentist directly for services rendered. Members are reimbursed from the DEA according to the fee schedule allowance. Members also have the option of choosing a dentist from the provider listing. You pay the dentist directly according to a Schedule of Allowance; or, upon receipt of reimbursement from the DEA, you endorse the check over directly to the dentist.
Medicare Part D
(Notice of Creditable Coverage)
If you do not opt for the Medicare Part D coverage, you will continue to receive full prescription drug benefits available to you under the Fund’s plan. The decision whether or not to enroll in Medicare Part D should be made after you review the benefits provided under Medicare Part D. This is an individual decision dependent upon your individual circumstances. Unless you or a dependent incur prescription bills in excess of the DEA’s $11,000 retired/$10,000 active annual cap, it would be in your best interest to remain with the DEA’s coverage.
In addition, there will be no change in your drug benefits simply because of your (or your dependent’s) eligibility for Medicare and you will not be required to enroll in Medicare Part D. If you do enroll in Medicare Part D, it will be your primary and only drug coverage. If your spouse/dependent is not eligible for Medicare Part D and you elect to take Medicare Part D, the DEA cannot cover your spouse/dependent under the DEA drug program.
If you have any questions please feel free to contact the DEA Fund Office at (212) 587-9120.
Drug Program
(Benecard Services Direct Reimbursement Claim Form)
Members, their spouses and children (up to their 23rd birthday) can use the Benecard Services drug card at participating pharmacies with a co-payment schedule as follows:
- $10 or less for generic prescriptions (not to exceed the cost of the medication);
- $10 or 30% for single source brands
- $10 or 30% for multi-source brands, plus the difference between the cost of the brand and generic drugs
- Asthma and psychotrophic drugs have a 45% co-pay
There is an annual plan year deductible (July 1- June 30) of $50 per individual and $150 per family prior to plan benefit coverage. There is an $11,000 cap for a family per year. Prescription drugs that have an over-the-counter equivalent are not covered under our drug plan.
Children from the ages of 19 to the date of their 23rd birthday (who have proper student verification on file with the DEA) will now be eligible to use the Benecard Services card to obtain their prescriptions, and simply pay the co-payment. Student verification must be submitted to the DEA twice each year for the fall and spring sessions. Please remember to submit student verification for the fall semester (which covers the time period between 9/1 and 2/28), and the spring semester (which covers the time period between 3/1 and 8/31). Click here for the DEA Student Verification Form.
Mail order – The maintenance (continuous medication) drug program entitles you to a three-month supply with a co-payment schedule per prescription as follows:
- $10 or 30% for generic prescriptions
- $10 or 30% for single source brands
- $10 or 30% for multi-source brands, plus the difference between the cost of the brand and generic drugs
- Asthma and psychotrophic drugs have a 45% co-pay
The City of New York is covering certain prescriptions (injectibles and chemotherapy drugs) under the PICA program. This program is available to all non-Medicare members who are enrolled in a City-sponsored Health Plan (NPA Express Scripts). Contact the DEA office or call NPA Express Scripts at (800) 467-2006 for more information. You may also visit NPA’s Express Script web site at www.e-npa.com
Prescription Drugs for Veterans
Prescription drugs can be obtained through the VA hospital in your area at the cost of a few dollars per prescription, regardless of disability. Contact your local VA hospital for more details, or contact the VA Health Benefits Service Center at (877) 222-VETS.
Optical Benefits
Member, spouse and eligible dependents are entitled to an eye exam and eye glasses once every 12 months.
What To Do If You Become Eligible for Medicare
When you or one of your dependents becomes eligible for Medicare at age 65 (and thereafter) or through special provisions of the Social Security Act for the Disabled, your first level of health benefits is provided by Medicare. The NYC Health Benefits Program provides a second level of benefits intended to fill certain gaps in Medicare coverage. In order to maintain maximum health benefits, it is essential that you join Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) at your local Social Security office as soon as you become eligible.
If you do not join Medicare, you will lose whatever benefits the city would have provided. The City of New York Health Benefits Program supplements Medicare but does not duplicate benefits available under Medicare. Additionally, should you not elect Medicare Parts A and B, you will be charged a significant penalty at a later date should you wish to obtain Medicare benefits. This penalty will apply each and every year in the form of a significantly higher Medicare Part B premium rate until you reach age 65. Also, Medicare-eligibles must be enrolled in Medicare Parts A and B in order to be covered by a Medicare HMO plan. The City of New York continues to reimburse 100% of your Medicare Part B premium on an annual basis. There is no charge for Medicare Part A. You must provide a copy of your Medicare card and completed Medicare Reimbursement Application to the City of New York in order to receive your annual Medicare Part B reimbursement.
What To Do When A Loved One Dies
In the event of the death of a DEA member, a spouse or beneficiary should be prepared to obtain copies of documents that will be needed by the union and by various agencies, organizations, and the government to straighten out the deceased’s estate. Click here for a list of documents that you will need.
HIPAA Notice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.