Sergeants Benevolent Association of the NYPD
SERGEANTS BENEVOLENT ASSOCIATION
CATASTROPHIC BENEFIT INFORMATION
SBA Roots
The roots of the SBA run as deep as those of the City of New York itself. In 1899, just one year following the consolidation of the city’s five boroughs and the formation of the NYPD, the Department’s supervisory officers formed a fraternal organization known as the Police Sergeants Endowment and Benevolent Association. The new group, led by President Oliver Tims, merged Sergeants’ organizations that had already existed in New York and Brooklyn for more than 10 years, and also included Lieutenants and other high-ranking officers among its membership.
The Catastrophic Coverage Benefit
The benefit pays up to 100 percent of reasonable and customary eligible expenses after a $2,000 out-of-pocket annual deductible per person has been reached. Eligible out-of-pocket expenses are those medical and hospital charges that are considered reasonable and customary by the Plan and are not fully reimbursed by the City Health Plan or private group insurers.
Benefit Limits and Maximums
There is a lifetime maximum benefit of $250,000 per covered person. Within this lifetime maximum, required and approved private duty nursing is covered in full for the first unpaid $25,000 and then at 50 percent for the remainder up to a lifetime maximum of $50,000.
Services or Charges Not Covered By the Catastrophic Benefit
In addition to the benefit exclusions of the SBA Health &Welfare Fund, the catastrophic benefit does not cover out-patient psychiatric care, prescription drugs, workers compensation benefit claims, occupational injury, illness or disease, fertilization, no fault auto insurance medical expenses, experimental procedures, any medical, surgical or hospital service/charge not approved for payment by a Member’s Participating Provider Organization (PPO) or Point of Service Plan (POS). Services rendered by non-participating PPO providers or out-of-network POS providers must be approved by the member’s health plan.
Submitting an SBA Catastrophic Benefit Claim
Once you have reached the $2,000 out-of-pocket, per-person annual deductible, complete and submit the catastrophic claim benefit form to the Fund office for processing. Instructions are printed on the form.
For additional information please contact the SBA Health & Welfare office at (212) 431-6555.