Law Enforcement Health Benefits Inc.

2233 Spring Garden Street | Philadelphia Pennsylvania 19130
Telephone 215-763-8290 | Fax 215-763-8808

John J. Gaittens, Administrator
Ray Convery, Assistant Administrator

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2019 COB/HIPAA Forms

Frequently Asked Questions

Question: Why do I have to fill out this form every year?


  1. It is required by the FOP/City of Philadelphia contract, Section VII. Health and Welfare, E. Coordination of Benefits. The form must be returned even if there is no other insurance coverage.
  2. Coordination of Benefits is required by the Pennsylvania Insurance Commission.
  3. Coordination of Benefits keeps our costs down.
  4. We need the signed form to handle any billing issues you might have. Without a signed HIPAA release form we cannot handle any of your bills.
  5. All forms must be returned by DECEMBER 31, 2018.

Question: Why do my spouse/adult dependent(s) have to fill out the HIPAA form every year?


  1. Without the signed HIPAA release form, no provider or facility will discuss any billing issues you send in to LEHB to handle for your spouse and adult dependent.

Question: Do I have to initial the Mental Health and Drug/Alcohol portion of the form?


  1. Independence Blue Cross requires a signed HIPAA release for the spouse and adult dependent for us to be able to discuss billing/treatment issues.
  2. The specific language is mandated by the Commonwealth of PA.
  3. We do not release this information to anyone.
  4. You, your spouse and/or adult dependent are not admitting to having these problems, it is only an authorization in case the need arises.
  5. We need the relevant initials in this section in case you, your spouse or adult dependent need any services in the upcoming year to discuss treatment with the facility. If the need arises, Magellan will not assist us in obtaining a facility without the signed HIPAA form.

Question: Do I need to obtain a letter from my spouse's employer stating that he/she does not have insurance?


  1. Yes, we need confirmation, every year, of the waived insurance or non-availability of insurance through the spouse's employer.

Question: Do my spouse and adult dependent(s) have to sign their own form?


  1. Yes, a separate form is required for the spouse and adult dependent(s).

Question: What if the information on my form is incorrect, can I write the correct information on the form?


  1. Yes, you can simply draw a line through the incorrect information and write the correct information on the form. However, if the incorrect info is due to an address change, divorce or name change, you need to call LEHB and request the proper change forms.


As you know, Police Officers make it a habit to be aware of their surroundings and to constantly evaluate locations and situations for threats. It is unfortunate that the same mindset should be used when dealing with healthcare providers and facilities.

The best advice we can offer to avoid large out of pocket expenses is to stay in the Blue Cross network. If you refer to the LEHB website, look at the Blue Cross Blue Shield Summary of Benefits and Coverage, click on "Summary of Benefits 2017" you will see that if you stay In-Network, there is NO deductible and the plan pays 100% of the costs unless otherwise noted.

However, if you go Out of Network, you will be subject to a deductible ($500.00 for Single and $1,000.00 for Family) additionally, the plan will only pay 50% of the In-Network allowable rate. The following simplified example will demonstrate how your costs could be significant. (This example does not include lab fees and other customary charges which can be very significant).

A member's adult dependent goes to an out of network addiction treatment facility. Their charge per day is $2,548.16 times 30 Days for a total cost of $76,444.80.

IBC will pay 50% of the In-Network daily rate. The daily In-Network rate is $454.00, 50% is $227.00 times 30 Days equals $6,810.00 The member will be charged the $500.00 Deductible, leaving $6,310.00

The Out of Network facility charged a total of $76,444.80 IBC would pay $6,310.00. The Out of Network facility could "balance bill" the member $70,134.80

NOTE: Per the Affordable Care Act, the balance-billed portion of your out-of-pocket expenses won't be credited toward your out-of-pocket limit.

Therefore, the member could be responsible for the full balance of $70,134.80

Specific Terminology: Always ask the Provider or the Facility if they are IN the Blue Cross Network. Some Providers/Facilities try to mislead the member by saying "we accept Blue Cross" or "we accept all insurance." That does NOT mean that they are "In Network" or will accept the Blue Cross payment as payment in full. You would be subject to pay the balance.

Flu Shot FAQ

Q: What is the most common reason that you hear that people do not vaccinate?
There are two main reasons people do not get vaccinated. First, they do not believe they are at risk or that getting sick would only be a minor inconvenience. While older people, young children and those with chronic diseases are at a higher risk of flu-related complications, it is important to remember that even healthy people can get very sick or even die. Plus, catching the flu often results in multiple days out of work, the cost of a doctors visit and treatment, as well as the risk of making family and co-workers sick. The flu is not a minor inconvenience. Secondly, they may think the vaccine does not work or can cause the flu. Currently, the flu vaccines effectiveness may vary from 10-60 percent from season to season, however, it is still the best single preventive measure that we have against this disease. (Researchers are working to develop a universal flu shot, but it is still in the early stages of development.) It is important to remember that the flu vaccine is manufactured from components of the virus and does not contain actual viral particles, so it cannot cause the flu.

Q: A lot of people say I do not get the flu, so why bother. How can they be convinced?
The past does not predict the future, and there is no way to guarantee that you will not get sick in a given flu season. Just because someone has not contracted the flu virus previously is not an indicator of future immunity because the virus changes year to year. It only takes walking by a sick person as they cough or sneeze in your general direction to get the flu. It remains important for everyone to take steps to prevent the flu and its spread.

Q: What is something you wish everyone knew about the flu?
Prevention is critical because you can pass along the flu virus before you show signs or symptoms. Once you develop the chills or a sore throat, you have likely been contagious for 24 hours, and you will be contagious until 5-7 days afterward. So, it is important to always practice good hygiene, because you never know when you might be spreading germs to others (and vice versa!).

Updated LEHB Personal Choice Benefits Booklet

The most up to date version of the LEHB Personal Choice Benefit Booklet is now available on the left hand side under the Blue Cross/Blue Shield tab the "Complete Benefit Booklet". This Benefit Booklet was produced by Independence Blue Cross and contains detailed information regarding your medical benefits.

Please Note: Information regarding you Dental Benefits is available under the Dental Benefits tab. Prescription Benefits information is under the Prescription Benefits tab and Vision Benefits information is available under the Vision Benefits tab.

If you have any question regarding your benefits, please call the LEHB Customer Service Team for assistance at 215-763-8290 Monday to Friday from 8:00am to 5:00 pm.


Recently, several members have had procedures (i.e. Surgery, Treatments, off-label use of Injectable Medications) performed that were determined to be experimental/investigational and not covered by Independence Blue Cross. Therefore our members were billed for the procedures. Before having a procedure done, check with Independence Blue Cross to make sure:

  1. The procedure is not experimental/investigational and that it will be covered under your plan.
  2. Any required Pre-Certifications or Prior-Authorizations have been obtained (If preapproval is needed and your Doctor is in the Independence Blue Cross Network, it is his or her responsibility. If you are out of the Independence Blue Cross service area (Philadelphia five-county area ) or you are using an Out-of-Network provider, it is YOUR responsibility)

Please call Independence Blue Cross at 1-800-ASK-BLUE (1-800-275-2583) provide the Customer Service Representative your Personal Choice ID number, the name of the procedure and the applicable procedure codes (if available).

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