FIREFIGHTER HEART AND CIRCULATORY MALFUNCTION BENEFITS PROGRAM STANDARD OPERATING GUIDELINES Approved by the DOLA Executive Director July 1, 2014

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1 FIREFIGHTER HEART AND CIRCULATORY MALFUNCTION BENEFITS PROGRAM STANDARD OPERATING GUIDELINES Apprved by the DOLA Executive Directr July 1, 2014 Prgram Overview: As f July 1, 2014, the Department f Lcal Affairs (DOLA) is respnsible fr administering the Firefighter Heart and Circulatry Malfunctin Benefits (FFB) Fund. Beginning January 1, 2015, DOLA will reimburse qualifying emplyers fr the csts f maintaining insurance cverage plans t prvide the benefits required by CRS t qualifying firefighters. Mneys in the FFB Fund will be used t reimburse emplyers fr the direct csts f maintaining insurance cverage plans required by Senate Bill Fr as lng as there are sufficient mneys in the FFB Fund, this prgram is designed t reimburse any qualifying emplyer that emplys ne r mre qualifying firefighters fr the direct csts f maintaining an insurance cverage plan that prvides the required heart and circulatry malfunctin benefits. T btain such a plan, the emplyer may purchase accident insurance, self-insure, participate in a self-insurance pl, r participate in a multi-emplyer health trust. These Standard Operating Guidelines have been established t assist DOLA staff with administering the FFB Prgram. These Guidelines als prvide guidance and instructins t emplyers when submitting reimbursement requests t DOLA. Prgram Eligibility: The fllwing entities are eligible t receive reimbursement as emplyers under the FFB Prgram: 1. A municipality that emplys ne r mre firefighters; 2. A special district that emplys ne r mre firefighters; 3. A fire authrity that emplys ne r mre firefighters; r 4. A cunty imprvement district that emplys ne r mre firefighters. T be qualified as a firefighter fr purpses f the FFB Prgram, an individual must: 1. Be an active emplyee f the emplyer; 2. Be a full-time emplyee f the emplyer wh regularly wrks at least ne thusand six hundred (1600) hurs in any calendar year; 3. Perfrm duties that are directly invlved with the prvisin f fire prtectin services; and 4. Have at least five years f cntinuus full-time emplyment with the emplyer. Fr each reimbursement request, the emplyer is required t certify that it is seeking reimbursement fr direct csts incurred t prvide the benefits required by CRS nly t qualified firefighters. Fr each reimbursement request, the emplyer is required t certify that the benefits ffered t the qualified firefighter(s) meet all f the minimum requirements f CRS DOLA reserves the right t cnduct nsite dcument review with emplyers t ensure reimbursements frm the FFB Fund are prvided t nly thse emplyers ffering the benefits as required by CRS t qualified firefighters. 1

2 List f Stakehlders: Clrad Divisin f Fire Preventin & Cntrl Clrad Prfessinal FF Assciatin Clrad State FF Assciatin Clrad State Fire Chiefs Assciatin Clrad Municipal League Special District Assciatin f Clrad Clrad Cunties Inc. PRIMA Clrad Chapter Frms: FFB Reimbursement Frm - Firefighter Heart and Circulatry Malfunctin Benefits Fund FFB Reimbursement Frm Instructins - Firefighter Heart and Circulatry Malfunctin Benefits Fund W-9 - Request fr Taxpayer Identificatin Number (TIN) Verificatin STANDARD OPERATING GUIDELINES DOLA staff will review and evaluate emplyer reimbursement requests, prcess apprved reimbursement payments, and assure adherence t these Standard Operating Guidelines. Fr purpses f administratin, these Standard Operating Guidelines may be amended by Prgram staff with input frm stakehlders and apprval f the Executive Directr f the Department f Lcal Affairs. The FFB Fund des nt pay individual firefighter s insurance plicies r claims. Qualified firefighters with questins abut their eligibility t cllect benefits must speak with their emplyer. DOLA des nt administer the actual benefits. Rather, DOLA nly reimburses emplyers wh are required t maintain insurance cverage plans t prvide the benefits required by CRS t qualifying firefighters. The FFB Fund will reimburse emplyers fr the direct csts f maintaining an insurance cverage plan required by CRS Fr as lng as there are sufficient mneys in the FFB Fund, this prgram is designed t reimburse any qualifying emplyer that emplys ne r mre qualifying firefighters fr the direct csts f maintaining an insurance cverage plan that prvides the required heart and circulatry malfunctin benefits. T btain such a plan, the emplyer may purchase accident insurance, self-insure, participate in a self-insurance pl, r participate in a multi-emplyer health trust. The FFB Prgram is nt intended t pay fr any insurance csts prir t the effective date f an insurance cverage plan that meets the minimum requirements f CRS (2). If during the curse f the State f Clrad s fiscal year all f the mneys in the FFB Fund are depleted, then the insurance cverage plan required t be maintained by CRS shall becme an unfunded mandate pursuant t CRS In such event, the emplyer may elect t btain an insurance cverage plan t prvide benefits fr qualified firefighters after the date f depletin, but will nt be reimbursed by DOLA fr the csts f ding s. DOLA staff will pst quarterly updates abut the balance f the FFB Fund n DOLA s website at 2

3 Prf must be prvided fr direct csts t be reimbursed and shuld accmpany the FFB Reimbursement Frm. There must be an invice fr each insurance cverage plan purchased shwing prf that includes the fllwing: the emplyer name cverage plan name cverage plan # and effective date cverage perid descriptin f insurance cverage plan type shwing cmpliance with CRS (2) dllar amunt f benefits # f qualified firefighters cvered cst t emplyer t prvide benefits A cmpleted FFB Reimbursement Frm must be submitted within 90 days f the effective date f any insurance cverage plan purchased by the emplyer. If there are extenuating circumstances fr a delay in prviding the cmpleted frm, the emplyer must attach an explanatin fr the delay. FFB Reimbursement Frms may be submitted fr insurance cverage plans with effective dates n r after July 1, 2014, hwever DOLA cannt reimburse emplyers fr any direct csts incurred t btain such plans until January 1, DOLA will prcess cmpleted FFB Reimbursement Frms in the rder that they are received. A frm is cnsidered cmpleted fr purpses f prcessing by DOLA if n further infrmatin r supprting dcumentatin is required by DOLA. DOLA will reimburse emplyers with mneys frm the FFB Fund based n the State f Clrad s fiscal year (e.g., July 1, 2014 thrugh June 30, 2015). All cmpleted FFB Reimbursement Frms fr any insurance cverage plan with an effective date during the prir fiscal year must be submitted t DOLA n later than July 10 f the fllwing fiscal year. Requests fr reimbursements fr the prir fiscal year submitted after July 10 f the fllwing fiscal year will be declined and may nt be resubmitted. FFB Prgram requests fr reimbursement may be declined if paid invices r paid receipts have nt been prvided by the emplyer. DOLA staff will cntact the emplyer t request the apprpriate dcumentatin and will allw 30 days thereafter fr submittal. If the requested infrmatin is nt submitted within 30 days, then DOLA s staff will decline the emplyer s request fr reimbursement. In the event that an riginal request fr reimbursement is declined, the emplyer may resubmit a cmpleted FFB Reimbursement Frm t DOLA. DOLA strngly recmmends that emplyers submit all cmpleted FFB Reimbursement Frms fr any insurance cverage plan with an effective date during the State s fiscal year n later than May 1 f the same fiscal year t avail themselves f the 30-day supplementatin perid and the pprtunity fr resubmittal cntemplated by these Standard Operating Guidelines. Fr each reimbursement request, the emplyer s authrized representative is required t certify that the emplyer is either: (1) a municipality that emplys ne r mre firefighters; (2) a special district that emplys ne r mre firefighters; (3) a fire authrity that emplys ne r mre firefighters; r (4) a cunty imprvement district that emplys ne r mre firefighters. Fr each reimbursement request, the emplyer s authrized representative is required t certify that the emplyer is seeking reimbursement fr the direct csts f btaining an insurance cverage plan that prvides the benefits required by CRS nly t qualified firefighters. 3

4 Fr each reimbursement request, the emplyer s authrized representative is required t certify that the insurance cverage plan prvides all f the minimum benefits required by CRS (2). DOLA reserves the right t cnduct nsite dcument review with and audits f emplyers t ensure that reimbursements frm the FFB Fund are prvided t nly qualified emplyers fr the direct csts f btaining insurance cverage plans that prvide all f the minimum benefits required by CRS (2) t qualified firefighters. It is expected that the emplyer will maintain true and crrect cpies f any insurance cverage plan purchased and will be respnsible fr assisting DOLA staff as needed with the prcessing f any reimbursement requests. If an insurance cverage plan is canceled r terminated within the eligible cverage perid, then the emplyer must ntify DOLA immediately. Upn review, DOLA may request a refund fr all, r a prtin, f any reimbursement previusly made t the emplyer. Adherence t the timeframes set frth by these Standard Operating Guidelines is highly recmmended. Each cmpleted FFB Reimbursement Frm must be signed by the emplyer s authrized representative. Mail Benefit Frm and supprting dcumentatin t: Department f Lcal Affairs Firefighters Heart & Circulatry Benefits Fund 1313 Sherman Street, Rm 521 Denver, CO Frequently Asked Questins: Q: Where in statute is the Firefighter Heart and Circulatry Malfunctin Benefits Fund (FFB) Prgram created? A: Statutry authrity fr the FFB Prgram is lcated in Sectin , et seq., f the Clrad Revised Statutes. Q: Where is the FFB Reimbursement Frm available? A: The reimbursement frm and instructins are psted n DOLA s website. Q: Wh is a qualified emplyer fr purpses f the FFB Prgram? A: The fllwing entities are eligible t receive reimbursement as emplyers under the FFB Prgram: (1) a municipality that emplys ne r mre firefighters; (2) a special district that emplys ne r mre firefighters; (3) a fire authrity that emplys ne r mre firefighters; r (4) a cunty imprvement district that emplys ne r mre firefighters. Q: Wh is a qualified firefighter fr purpses f the FFB Prgram? A: T be qualified as a firefighter, an individual must: (1) be an active emplyee f the emplyer; (2) be a full-time emplyee f the emplyer wh regularly wrks at least ne thusand six hundred (1600) hurs in any calendar year; (3) perfrm duties that are directly invlved with the prvisin f fire prtectin services; and (4) have at least five years f cntinuus full-time emplyment with the emplyer. Q: What is DOLA s rle in the FFB prgram? A: Fr as lng as there are sufficient mneys in the FFB Fund, DOLA will reimburse emplyers fr the direct csts f btaining insurance cverage plans that prvide the benefits required by 4

5 CRS t qualified firefighters. DOLA staff will review and prcess emplyer reimbursement requests. DOLA staff will als administer the FFB Fund and mnitr the fund balance. Q: Where d I send my cmpleted FFB Reimbursement Frm? A: Send yur cmpleted reimbursement frm and all supprting dcumentatin t the Department f Lcal Affairs, Firefighters Heart & Circulatry Benefits Fund, 1313 Sherman St., Rm 521, Denver, CO Q: Will actual injury claims be submitted t DOLA? A: N nly the direct csts incurred by qualified emplyers fr btaining an insurance cverage plan that prvides the required benefits t qualified firefighters are eligible fr reimbursement by DOLA. Q: Will DOLA reimburse emplyers wh prvide benefits t vlunteer firefighters? A: N DOLA will nly reimburse qualified emplyers required t btain an insurance cverage plan t prvide heart and circulatry malfunctin benefits t qualified firefighters. Q: Wh d I call with questins? A: Glry Ortega, Prgram Manager at 303/ , [email protected] 5