INFORMATION AND NOTIFICATIONS CHECKLIST

FAMILY DOCUMENTS SHOULD BE KEPT WHERE THEY ARE PROTECTED FROM FIRE AND THEFT, YET READILY AVAILABLE. CLAIMS FOR BENEFITS MAY REQUIRE DETAILED SUPPORT OR EVIDENCE FROM THESE DOCUMENTS AND OTHER IMPORTANT PAPERS. MEMBERS AND THEIR FAMILIES SHOULD SAFEGUARD THIS INFORMATION INCLUDING SEPARATION PAPERS, DEATH CERTIFICATES, DIVORCE DECREES AND GUARDIANSHIP OR CHILD CUSTODY EVIDENCE

Click on link below for Information and Notification Form. Enter necessary information then print.

Vital Information Form

NOTE: Prompt notification of a Retired Member's death should be reported to:

New York City Fire Department, Bureau of Personnel
9 MetroTech Center, Brooklyn, New York 11201.
(718) 999-2320 or (718) 999-2327, 2328, 2329

Final retirement check received after a Retired Member's death must be returned to the Pension Fund.
Note: Pension checks are pro-rated, Ex: If a member dies on Jan 3rd the check received on approxamiately the 31st of December need not be returned, the check was issued for the previous month and the pension bureau will send an application to the widow or family for payment to the widow or family from January 1st to date of the members death.

Approximately two (2) weeks after a Retired Member's death, the Pension Section of the New York City Fire Department will send eligible beneficiaries the following:
Article 1 Survivors:
1- Application for unpaid retirement allowance from the 1st of the month to the date of death.
2- Claim form for NYFD Life Insurance to designated beneficiary.
3- Application for widows pension to the widow at the time of death.

Article 1 retirees (appointed before 1939): 1- Application for unpaid retirement allowance from the 1st of the month to the date of death
2- Claim form for NYFD Life Insurance to designated beneficiary. 3- Application for widows pension to the widow at time of death.

Article 1 B-Survivors: - 0riginal Plan Retirees, Tier II Retirees, and Improved Benefit Plan (IBP) Retirees.
1- Application for unpaid retirement allowance from the 1st of the month to the date of death.
2- Claim form to designated beneficiary for NYFD Life Insurance.
3- Application to designated beneficiary for joint survivor pension if the Member selected an option at the time of retirement.

BENEFITS FROM OTHER SOURCES

Check for pending reimbursement of Medicare Part "B" deductions for the year of death and the year preceding death. These payments should be received during the summer of the year following the Medicare premium deductions from decedent's monthly social security check. If not received, contact the NYC Employee Benefits Program-Medicare Reimbursement Unit, 40 Rector Street, New York, New York 10006. (212) 513-0470 pro-rated share of annual $200 cash bonus for transfers to Medicare HMO effective 7/1/95.

NOTE: It's extremelyu difficult if not impossible to contact this office at the above number. Either write to the above address or contact via www.nyc.gove/html.olr (NYC Retired Emplyees Infomation).

* Any Other Employment Benefit Coverage
* UFA Death Benefit (Associate Member) (212) 683-4832
* UFOA Death Benefit (representatives)at Family Protection Plan (212) 376-8400
* UFOA Group Life Insurance for Post 2/1/86 Retirees
* UFA Group Life Insurance for Post 3/1/78 Retirees
* UFOA or UFA Individual Life Insurance policy converted or purchased at the time of retirement.
* Home Mortgage Life Insurance
* Life Insurance Policies on children with waivers of premium.
* Credit Life Insurance
* Second Career Employment Coverage
* American Legion, Veterans of Foreign Wars, Business, Religious, Trade, or other Fraternal Organizations

REQUIRED FOR PROCESSING OF THE ABOVE

1) Copy of Transcript (death certificate)
2) Marriage Certificate
3) Birth Certificates of Minor Children
4) Paid Funeral Bill
5) Social Security Number

In addition to the above, all widows are eligible for the following services:
AMBULANCE & OXYGEN THERAPY
251 Lafayette Street, New York, NY 10007
(212) 570-4252.

It is recommended that the widow continue payments to the:
NYFP Surgical Assistance Fund
9 MetroTech Center
Brooklyn, New York 11201-3857
(718) 999-1252 or (718)-999-1253.

NOTE: UFA pays the yearly dues for its eligible Retirees.

UFOA CATASTROPHE Major Medical Insurance

To obtain claim forms or information on continuation of coverage for surviving spouse, eligible dependents, call toll-free 1-800-503-9228. When a retired member dies and notification is made as noted above, a credit will be made for the decedents unused premium from the date of death to the end of semi-annual premium period. The insuring co is United States Life Insurance Company in the City of New York. Customer Service 1-800-503-9230.

Note: The widow must contact the above number(s)in order to maintain the catastrophic coverage. Premiums must be paid by the widow.FYI, it's a two million dollar policy for medical coverage, over and above the primary health insurance, Medicare, GHI, etc.

HEALTH PLAN COVERAGE

When the health plan carrier (GHI, HIP or other HMO) is notified by the City of the death of a Retired Member, the health plan carrier will notify the widow of the termination of health plan coverage. At the same time, they will include with such notice, applications for continuation of health plan coverage as provided by the COBRA legislation or by direct payment, so that the widow may continue uninterrupted medical and Blue Cross hospital coverage. The payments will be retroactive to the date the City terminated coverage so there is no loss of either coverage. This notification takes time. Generally, it is eight (8) weeks before the widow receives such notice. In the meantime, continue to use the identification cards you have for any required medical or hospital service If notification is not received two months after the Member's death, contact the New York City Employee Health Benefits Program, 40 Rector Street, New York, New York 10006 (212) 513-0470.

Note: it is difficult to contact anyone at the above number, try writing to above address or contact by email at website www.nyc.gov/html/olr.

Firefighters - 3/4 and Serivce Retirements

Spouses are covered in memberís health plan for one year after death. Spouse may pick up health insurance up to 1 year from death of firefighter at a cost of 102% of the Cityís contribution. Please review rates to determine if this is the best possible insurance for your situation. If you decide on this option please file the appropriate form within 9 months of death to allow necessary paperwork. You cannot choose this option after a year of the firefighterís death.

Officers - 3/4 and Serivce Retirements

Widows are covered by the UFOA under members health plan til the end of the month of retired members death. Widows who wish to continue their coverage may do so. Please refer to above information as it applies to you.

IMPORTANT:3/4 retirees, both UFA and UFOA. If the cause of death is directly related to the 3/4 retirement the widow is entitled to the COBRA benefits for the rest of her life. This must be approved by the City, after necessary paperwork has been forwarded to the widow, completed and returned. The health plan carrier will follow up with the widow in ordr to maintain the benefits for life.

IMPORTANT: Service retirees, both UFA and UFOA. Notifications must be made to the pension bureau as above in order to maintain COBRA coverage. The widow must pay the premiums after the necessary paperwork is forwarded to widow, filled out and returned.

Widows who wish to continue their health coverage should use link below, print form, complete and send to Rector St. It may be wise to enclose a self-addressed stamped envelope.

Eyeglasses, Dental, Drug and Hearing Aids

These items are covered by the UFOA. UFA members may need to confirm this with their union.

Form Letter

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