See how your benefits protect
you and your loved ones

Frequently Asked Questions

Some of the questions and concerns you have about our process and around benefits may already be answered here. This office helps administer the retiree’s health care benefits plan. Some of those specific questions are answered here, but are expanded on more formally in the Plan Document.

APPOINTMENTS

How do I make an appointment with a Fund Benefit Specialist?

Call our office at (866) 652-4237 to make an appointment with a Fund Benefit Specialist representative.

What do I need to bring to the appointment?

To make the appointment an effective use of your time, please bring the following items:

Social Security card
Marriage certificate
Other proof of spouse’s insurance (if any)
Birth certificate
Projection Report — Obtained from the San Antonio Fire & Police Pension Fund (this is a separate office). Call (210) 534-3262 or visit safppf.org

FAMILY

Will my spouse be covered?

Spouses as of the date of retirement are covered. If you get a divorce, your ex-spouse will no longer be covered. If you re-marry, your spouse will not be covered.

Can I add my spouse and children at a later date?

No.

Will my spouse remain on the plan if I die?

Your spouse can remain on the plan unless they re-marry. If an eligible widow/widower on the plan marries, they will lose their eligibility.

Are children covered?

Children are covered up to age 23. Children adopted after retirement date are not covered.

Am I covered while traveling?

Yes, under out-of-network policies.

COVERAGE & MEDICARE

Can I keep my doctor?

The plan has a considerable amount of doctors who qualify as in-network options. You can keep your doctor even if they are not in-network, but you will be responsible for out-of-network billing.

Is dental or vision covered?

No. The plan is for medical health care coverage only.

Are there any Medicare requirements?

Once a covered person is eligible for Medicare either by age or established criteria for Medicare eligibility a covered person is required to apply for, purchase and maintain Medicare Part A & B Benefits. If a covered person does not have the eligible quarters for Medicare Part A the covered person will need to provide a copy of the Notice of award letter to the Health Fund Office.

PLANS & BENEFITS

The Fund Health Care Plan provides retired San Antonio Firefighters and Police Officers with comprehensive health benefits for themselves and their dependents. Learn about insurance coverage, benefits, past plan highlights and more by clicking the buttons below.

BENEFIT HIGHLIGHTS

MEDICAL PLAN

Medical Plan

WEBTPA

Third Party Administrator

IMPORTANT NOTE: Precertification is required regardless of primary insurance. Precertification guidelines apply to ALL members.

Pre-Certification, Eligibility, and Claims Information

Provider Services: (877) 349-4400
Member Services: (866) 652-4237
Other proof of spouse’s insurance (if any)

To File A Claim:

To file an electronic claim(s), submit to: WebMD/Envoy Payor ID #75261

To mail your claim, the address is: WEBTPA, P.O. Box 99906, Grapevine, TX 76099-9706

To register your Member Portal Account, please refer to the instructions HERE.

WELLDYNE

Alternative Therapy List

Welldyne Member Services: (800) 479-2000
Pharmacy Help Desk: (888) 886-5822
Specialty Rx Member Services: (800) 641-8475
For any issues or concerns, members can call (800) 652-4237

FEDERAL NOTICES

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