EB-5 Firefighter Cancer BenefitCITY OF DELRAY BEACH
ADMINISTRATIVE POLICIES AND PROCEDURES
DEPARTMENT:
SUBJECT:
REVISION:
APPROVED BY:
Human Resources POLICY NUMBER:
Firefighter Cancer Benefit SUPERSEDES:
EFFECTIVE DATE:
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June 14,2021
Terrence R.Moore,City Manager
EB-15.0 PURPOSE:
This policy is designed to establish a method to record,assess and adjudicate benefits pursuant to the Firefighter
Cancer Benefit under §112.1816 Florida Statutes.Pursuant to this Statute,a Firefighter has the opportunity to
elect to receive care for certain cancers under Worker's Compensation or through the City's group health plan.
Firefighters who choose to receive treatment through Workers'Compensation are ineligible to request
compensation through the Firefighter Cancer Benefit.For those Firefighters who elect to receive treatment
through the City's group health plan,this Policy provides information and the required forms to request a one-
time lump sum cancer benefit and reimbursement of out-of-pocket copays,deductibles or coinsurance for cancer
treatment.
EB-15.1 POLICY
A.Eligibility Requirements
1.Claimant has a cancer diagnosis on or after July 1,2019 of one of the 21 types of cancer included in the
Firefighter Cancer Benefit statute.
2.Claimant has been employed by City of Delray Beach for at least five (5)continuous years prior to
receiving benefits.
3.Claimant has not used tobacco products for at least the preceding five (5)years prior to receiving benefits.
4.Claimant has not been employed in any other position outside of City of Delray Beach in the preceding
five (5)years which is proven to create a higher risk for any cancer.
8.Post-Employment Eligibility Requirements
1.Claimant has not been employed as a firefighter with another employer during the 10-year period after
employment terminates with the City of Delray Beach.
2.Reimbursement of out-of-pocket cost shares and the one-time cash lump sum benefit are to be paid to a
claimant for up to ten (10)years after employment terminates,provided the claimant meets the criteria
specified in §112.1816,Florida Statutes.
3.Benefits are not owed to a firefighter who is subsequently employed elsewhere_as a firefighter following
their employment termination date from the City of Delray Beach.
4.Employment termination may occur due to the firefighter's resignation,dismissal,disability,or retirement.
5.Claimant must have elected to continue coverage under a City of Delray Beach group health plan upon
separation of employment.Election of coverage under retirement or continuation of coverage under
COBRA due to a qualifying event are both deemed elections of coverage.
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C.Reimbursements of Cancer Treatment:
1.The diagnosis of cancer must have occurred with a date of service of July 1,2019 or later when
determining eligibility for cost-share reimbursements such as out-of-pocket copays,deductibles or
coinsurance.
2.Reimbursement of cost-shares for cancer treatment are not eligible if incurred prior to July 1,2019;
however,reimbursements of cost-shares incurred after July 1,2019,even if the cancer diagnosis was
prior to July 1,2019,are eligible for reimbursement.
3.Actual treatment must be covered within the City's group health plan for the reimbursement of cost-shares
incurred due to the treatment of cancer.
4.Only copays,deductibles,or coinsurance subject to the out-of-pocket limits under the City's group
medical plans are reimbursable.See Summary of Benefits and Costs and/or the Summary Plan
Document for each plan for applicable maximum out-of-pocket limits.
5.Investigative or experimental cancer treatment is not reimbursable because it is not covered within the
City's group health plan.General out-of-pocket healthcare costs,such as balance billing,personal care
items,meals,etc.are also not reimbursable.
6.Claimant may not seek reimbursement from City of Delray Beach for any prescription drug coinsurance
that is otherwise already paid or applied to be payable under a copay assistance card,copay savings
program,copay coupon or copay card,or any other pharmaceutical or other company's financial or
patient assistance program.Claimant shall agree to reimburse the City of Delray Beach for any
reimbursement amount which has also been paid or payable under any assistance program noted above.
D.One-Time Lump Sum Cash Benefit:
1.This is a $25,000 one-time cash lump sum benefit upon initial diagnosis of cancer after July 1,2019.
Cancer diagnoses prior to July 1,2019 are not eligible for the one-time cash lump sum benefit.
2.The one-time cash lump sum benefit is allowed only for the initial diagnosis of one of the cancer types
enumerated in the statute.This cash lump sum benefit is not provided or allowed for subsequent new
diagnosis,or reoccurrence of the same diagnosis that was formerly in remission.The cash lump sum
benefit is not owed more than once regardless of how many diagnoses of cancer or body parts.
EB-15.2 PROCEDURE
A.Affidavits
1.Claimant will contact Employee Benefits in Human Resources to obtain the Florida Firefighter Cancer Bill
Payout and Voluntary Reimbursement Program Employee Packet (the "Employee Packet"),which is
attached hereto as Appendix 1.
2.Claimant will complete all applicable affidavits,provide documentation listed in Section B,below,and
submit the completed Employee Packet to Employee Benefits in Human Resources.
3.Human Resources will review the medical documentation and the completed Employee Packet for claim
eligibility and notify the claimant of the status of the claim in a timely manner.
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B.Documentation to support claims
The claimant will provide along with the completed Employee Packet the following documentation:
1.A copy of the insurance carrier's Explanation of Benefits (EOB)to clarify Current Procedural
Terminology (CPT)code,treatment date of service,and cancer treatment under a cancer diagnosis.
2.A copy of EOBs for reimbursement of out-of-pocket copays,deductibles,and coinsurance related to
treatment of cancer
3.Receipts,credit card charges,checking account debit charges as proof of payment to support the
corresponding EOB.
C.Funding and payment:
1.Once the claim is approved,Human Resources will submit a check request to the City's
Finance Department for payment using only the employee name,date of service and
"benefits pursuant to §112.1816 Florida Statute."No diagnosis or protected health
information is to be provided with the check request.
D.Affidavits in Employee Packet (See Appendix 1)
Florida Firefighter Cancer Bill Payout and Voluntary Reimbursement Program Employee Packet
is attached hereto.
1.Authorization of Use and Disclosure of Private Health Information to Third Parties
2.Notice of Initial Diagnosis and Claim of Benefits
3.Affidavit-No Tobacco Product Use in Preceding Five (5)Years
4.Affidavit of All Employment in Preceding Five (5)Years From Date of Diagnosis
5.Post-Employment Affidavit for Terminated Employees Only
6.Request for One-Time Initial Diagnosis Benefit $25,000
7.Out of Pocket Reimbursement Request Form