This FAQ page briefly answers some of the most common questions about the World Trade Center (WTC) Health Program. It’s not a complete explanation of the Program and its services. For more information about the Program and more details about these topics, see the Member Handbook and other links within the FAQ.

Please note: This information is written to make the information easier to understand. For legal or administrative purposes, please refer to the official sources that state policy and procedure in formal language.

The WTC Health Program and How it Works

  • What is the WTC Health Program?

    The World Trade Center (WTC) Health Program is a federal program that provides monitoring and treatment for certified WTC-related health conditions for eligible Responders to the September 11, 2001 attacks in New York City (NYC), the Pentagon in Arlington, Virginia, and the crash site in Shanksville, Pennsylvania. The Program also provides benefits to eligible Survivors who lived, worked, went to school, childcare, or adult day care in the NYC Disaster Area in the days after 9/11, and those who were in the dust or dust cloud on 9/11. In addition, the Program conducts scientific research to better identify, diagnose, and treat physical and mental health conditions related to 9/11 exposures.

  • What is the James Zadroga 9/11 Health and Compensation Act of 2010?

    On January 2, 2011, President Obama signed the James Zadroga 9/11 Health and Compensation Act of 2010 (Zadroga Act) into law (Public Law 111-347). The Zadroga Act modified the Public Health Service Act to extend and improve protections and services to individuals directly impacted by September 11, 2001.

    The Zadroga Act established or reauthorized the following three programs that help those directly affected by the September 11, 2001, attacks:

    • The WTC Health Program;
    • The September 11th Victim Compensation Fund; and
    • The WTC Health Registry

    On December 18, 2015, the President signed legislation to reauthorize the Program, extending it another 75 years, until 2090. In 2019, legislation was signed into law increasing the number of individuals who can be newly enrolled in the WTC Health Program. The Zadroga Act lays out the administrative structure of the WTC Health Program and establishes the criteria for enrollment, certification, health monitoring, and treatment.

    The Zadroga Act is federal law and changes to it require an act of Congress. Therefore, the Program cannot make exceptions to requirements set by the Act (for example, the Program cannot enroll someone who does not meet the requirements laid out in the Act).

    For more information on the Zadroga Act, visit the Program Laws page.

  • Are the WTC Health Program and the Victim Compensation Fund the same thing?

    No, the September 11th Victim Compensation Fund (VCF) is a separate program from the WTC Health Program and is administered by the U.S. Department of Justice.

    They’re both part of the James Zadroga 9/11 Health and Compensation Act of 2010 (the Zadroga Act), but the WTC Health Program provides medical monitoring and treatment for Responders and Survivors while the VCF provides financial compensation to individuals (or a personal representative of a deceased individual) who were present at the World Trade Center or in the NYC Exposure Zone (see https://www.vcf.gov/nyc-map-exposure-zone ); the Pentagon crash site; or the Shanksville, Pennsylvania, crash site, at some point between September 11, 2001, and May 30, 2002, and who have since been diagnosed with a 9/11-related physical illness.

    The VCF does not compensate for mental health conditions and does not distinguish between responders and survivors. The two programs have different eligibility criteria and application processes. If you’re a member of the WTC Health Program, you are not automatically enrolled in the VCF.

    To find out more about the VCF, visit www.vcf.gov or call 1-855-885-1555.

  • Does the WTC Health Program cost me anything?

    No. There are no application fees, premiums, co-pays, or out-of-pocket costs for members of the WTC Health Program for exams, tests, treatments, medical devices, or medications for medically necessary treatment of certified WTC-related health conditions within the Program network. You need to use the healthcare providers and pharmacies affiliated with the Program for it to cover these costs.

    For Responders, the Program directly pays for all monitoring, treatment, and medication costs of a certified WTC-related health condition, except if a Responder has a workers’ compensation claim for the certified condition.

    For Survivors, your primary, individual health insurance (private and/or public) pays its share of the cost for your care first, and the Program pays the rest. This is known as Coordination of Benefits and is a process required by the Zadroga Act. For initial health evaluations and annual monitoring exams, the Program pays in full. Learn more about this process in the Coordination of Benefits section of the member handbook.

    Note: If your certified condition is work-related and you have a workers' compensation claim for the condition, the Program will pay initially and then seek recoupment from either the workers' compensation carrier or the settlement, where applicable. View Worker’s Compensation FAQs to learn more.

  • How does the WTC Health Program work?

    First, you should determine whether you may be eligible for the Program as either a Responder or a Survivor. Then complete an application and include the required supporting documentation. Visit the How to Apply page for more details on the application process.

    The Program will evaluate your application to determine whether you meet the eligibility requirements. Once you’re enrolled, the Program sends you a letter explaining how to schedule an initial health evaluation (sometimes called a baseline exam, initial monitoring exam, or initial screening) at one of the Program clinics or in the Nationwide Provider Network (NPN). If your provider determines, based on the evaluation, that you may have a WTC-related health condition substantially likely to be related to your 9/11 exposure, your provider will ask the Program to certify the condition.

    Once the condition is certified, you can receive medically necessary treatment for that condition from Program clinics and affiliated providers at no out-of-pocket cost to you. If you need prescription medication or medical devices for your condition, those are also covered.

    View condition FAQs to learn more. View certification FAQs to learn more.

  • Who is a Responder?

    Responders worked or volunteered onsite in rescue, recovery, demolition, debris cleanup, or related support services in response to the September 11, 2001, attacks at the World Trade Center or related sites in New York City; the Pentagon in Arlington, Virginia; or the crash site near Shanksville, Pennsylvania.

    See the Eligible Groups page for more detailed information on who qualifies as a Responder.

  • Who is a Survivor?

    Survivors were in the dust or dust cloud in the New York City Disaster Area on September 11, 2001; or worked, lived, or attended school, childcare, or adult daycare in the New York City Disaster Area for certain timeframes on and or shortly after 9/11. The Zadroga Act does not allow for enrollment of non-responders at either the Pentagon or Shanksville, Pennsylvania sites.

    See the Eligible Groups page for more detailed information on who qualifies as a Responder.

  • Why should I enroll now since 9/11 was a long time ago?

    You may have a health condition related to your 9/11 exposure and not know it—many people don’t realize that chronic cough, heartburn, or anxiety might be related to their 9/11 exposure. Some conditions, like cancer, can take several years to develop after exposure. WTC Health Program providers are experts at recognizing and treating the kinds of WTC-related health conditions seen in Responders and Survivors.

  • Can someone help me understand my eligibility and benefits?

    Once enrolled, benefits counselors at your clinic can work with you to find out what additional benefits you may be eligible for both inside and outside the WTC Health Program. They can help explain those benefits and how to apply for them, and tell you how the Program coordinates with those benefits. Benefits outside the Program could include Workers’ Compensation, the September 11th Victim Compensation Fund (VCF) , disability, cancer care, social services, and treatment for health conditions that are not WTC-related.

    You can find out more about benefits counseling in the Member Handbook and from your Program clinic.

  • Can I choose somebody to represent me when applying to the WTC Health Program?

    Yes. You can choose a designated representative—someone who has your permission to speak and act on your behalf and to see and hear your personal information—for Program administrative matters like enrollment, certification, and appeals.

    Legal guardians can also act on behalf of an applicant/member if an original or certified copy of a court order appointing guardianship is provided. Please note that the WTC Health Program does not generally accept Powers of Attorney.

    For more information, see Using a Designated Representative in this FAQ, or the Designated Representative page.

  • What is a designated representative in the WTC Health Program?

    A designated representative is someone you choose who has your permission to speak and act on your behalf and to see and hear your personal information for WTC Health Program administrative matters like enrollment, certification, and appeals. A designated representative cannot make treatment decisions for you.

    Your designated representative may be a family member, a friend, or your attorney. However, you can have only one designated representative at a time. You can change representatives in writing at any time. Once you choose a designated representative, everything the Program sends to you may also be sent to your representative. Please note that the WTC Health Program does not generally accept Powers of Attorney for administrative matters.

    To learn more about designated representatives and how to designate one, see the Designated Representative page.

  • Does the WTC Health Program accept Powers of Attorney for enrollment, designated representative, or other administrative matters?

    The WTC Health Program does not generally accept Powers of Attorney for administrative matters. This includes signing and/or submitting an application on an individual’s behalf, signing Designated Representative forms on an individual’s behalf, and otherwise interacting with the WTC Health Program on an individual’s behalf.

    However, each applicant/member can appoint a designated representative to act on their behalf and represent their administrative interests in the WTC Health Program. Legal guardians can also act on behalf of an applicant/member if an original or certified copy of a court order appointing guardianship is provided.

    To learn more about designated representatives and how to designate one, see the Designated Representative page.

  • Is this a research program?

    The WTC Health Program research program plays a vital role in the treatment of your condition and the Program’s ability to add a condition to the List of WTC-Related Health Conditions.

    For members in the NY metropolitan area, when you come in for an exam, you will be asked if the CCE can add your medical information to the data which researchers are using to understand 9/11 health effects.

    Participation is optional and any information collected is maintained in accordance with strict requirements for privacy and confidentiality. You will receive your exam and continue to receive treatment, even if you do not agree to share medical information for research purposes.

Enrollment in the WTC Health Program

  • How do I know if I am enrolled in the WTC Health Program?

    You’re enrolled in the Program if:

    • You applied to the WTC Health Program and received an acceptance letter; and/or
    • You were previously enrolled in the WTC Medical Monitoring and Treatment Program (MMTP) as an FDNY member (active or retired), a New York City responder, or a New York City volunteer. The WTC Health Program replaced the MMTP in July 2011; or
    • You were enrolled in the WTC Environmental Health Center Community Program. The WTC Health Program replaced the WTC Environmental Health Center Community Program in July 2011.

    If you’re not sure if you are enrolled, you can call the WTC Health Program helpline at 1-888-982-4748, Monday through Friday, 9 a.m. to 5 p.m. (Eastern).

  • How do I apply to the WTC Health Program?

    You can apply through the Program’s online application system, OASIS, or you can download an application form to print out and mail or fax. You also need to gather and send required supporting documentation with your application. We cannot process your application unless we also have your required supporting documentation.

    Application forms are available in English, Español, Polskie, and 中文. The OASIS online application is currently available only in English.

    You can also call the Program helpline at 1-888-982-4748, Monday through Friday, 9 a.m. to 5 p.m. (Eastern), and ask for an application to be mailed or faxed to you.

    You should apply only once, either online or by mail/fax.

    For more information, see the How to Apply page.

  • What supporting documentation do I need when applying?

    If you are applying as a Responder, you need to provide documentation that shows you worked at one or more of the World Trade Center sites, the Pentagon, or the Shanksville, Pennsylvania site. The documents must show all of the following information:

    • The type of work you performed (activity);
    • The address and/or street name of where you worked (location);
    • The time period you worked at each location (date range); and
    • How many hours per day, week, or month you worked at each location.

    If you are applying as a Survivor, you need to provide documentation that shows one or more of the following:

    • Address of your home, workplace, school, daycare center, or adult daycare center and dates of residence or attendance;
    • Proof of presence within the NYC Disaster Area and confirmation of exposure to the dust or dust cloud on September 11, 2001; or
    • Proof of eligibility to receive a residential grant from Lower Manhattan Development Corporation (LMDC)
    • Residential Grant Program or proof of your employer receiving a LMDC grant.

    For examples of supporting documentation, see the Required Supporting Documentation page.

    If you have questions about your required supporting documentation, call the WTC Health Program helpline at 1-888-982-4748, Monday through Friday, 9 a.m. to 5 p.m. (Eastern).

  • What if I can’t get copies of my supporting documentation?

    If you can’t get copies of your official supporting documentation, you can submit a letter written by someone who can confirm the details of your eligibility. This is called a third-party attestation.

    If you can’t find official supporting documentation or someone to write a third-party attestation, you can personally write a letter that includes the required eligibility information. This is known as a first-party attestation. Along with the first-party attestation, you must also include details about:

    • What you did to try to get documentation, and
    • Why you can't include it.

    Both types of attestations must contain the required specific information about your activities and location and be signed by the writer as truthful under penalty of law. You can find more information about attestations on the Required Supporting Documentation page.

  • What if my name has changed from what is on my documentation?

    If your current name does not match what is on your supporting documentation, you must also send in documentation of your name change (such as a copy of your marriage certificate, divorce decree, adoption decree, or court order) with the rest of your supporting documentation.

  • How long will it take to process my application?

    If you have included all the required information on your application and sent all the necessary supporting documentation with it, it will generally take a few weeks to review and process. Every application is different, however, and some reviews may take longer.

    If your application is missing information, your application review will be delayed or suspended. If that happens, a WTC Health Program enrollment specialist will contact you by phone, email, or mail to help you complete your application.

  • How do I check the status of my application?

    Call the WTC Health Program helpline at 1-888-982-4748, Monday through Friday, 9 a.m. to 5 p.m. (Eastern), to check the status of your application.

  • What if my enrollment is denied?

    If your enrollment is denied, we will send you a letter explaining why it has been denied. You have the right to appeal this decision. Please see the Appeals section of this FAQ for more details.

  • What if my enrollment classification is wrong and needs to be changed?

    Your enrollment classification is whether you are enrolled as a Responder or Survivor in the Program. If you receive your enrollment acceptance letter and you feel the classification is incorrect, call the WTC Health Program helpline at 1-888-982-4748, Monday through Friday, 9 a.m. to 5 p.m. (Eastern). The helpline representative will tell you what you need to do to request a change in your classification.

  • How do I update my member contact information?

    If your member contact information (such as your address or phone number) has changed, call both your Clinical Center of Excellence (CCE) or Nationwide Provider Network (NPN) clinic and the WTC Health Program helpline at 1-888-982-4748, Monday through Friday, 9 a.m. to 5 p.m. (Eastern), as soon as possible to update your information.

    If you have moved away from your clinic and need to transfer to another clinic closer to your new residence, please see Can I change clinics? in this FAQ for information on how to transfer.

Initial Health Evaluation, Certification, and Treatment Coverage

  • Where can I go for evaluations and for treatment in the WTC Health Program?

    In the New York metropolitan area, there are several Clinical Centers of Excellence (CCEs) specializing in either Responder or Survivor care. Outside the New York metropolitan area, both Responders and Survivors can go to a provider closer to your home through the Nationwide Provider Network (NPN).

    If you live in the New York metropolitan area, your enrollment letter will explain which clinics you can go to for your evaluation and any necessary treatment. If you live outside the New York metropolitan area, you’ll get a welcome packet from Logistics Health Incorporated (LHI), a contracted medical provider for the Program. LHI administers the NPN. The packet will explain how to find a clinic near you.

  • Will I get a coverage card (aka health card or insurance card) from the WTC Health Program?

    Every WTC Health Program member is assigned an individual member ID number. When you are enrolled, your member number will be on your welcome letter. Keep this number handy as you may be asked for it when calling the WTC Health Program helpline or when talking with your clinic.

    If your Program clinic is one of the Clinical Centers of Excellence in the New York metropolitan area, you don’t need a coverage card and won’t receive one. If you’re outside the New York metropolitan area, you’ll receive a coverage card from the Nationwide Provider Network.

    You will receive a pharmacy benefits card from Optum, the Program’s Pharmacy Benefits Manager.

    View pharmacy benefits FAQs to learn more.

  • Who do I call to schedule, reschedule, or confirm an appointment?

    Call your CCE/NPN directly for scheduling or questions about appointments. The WTC Health Program helpline doesn’t have information about appointments and can’t schedule them for you.

    You can find contact information for each clinic on the Find a Clinic page.

  • What will happen at my initial health evaluation?

    Your first appointment—known as your initial health evaluation or baseline monitoring exam—is to check for possible WTC-related health conditions. Your WTC Health Program provider will run tests and gather information about your health.

    The evaluation will take about two to four hours. Your provider will talk with you after the evaluation about the initial results, and you’ll get a final report later with the results of your lab tests.

    At your initial health evaluation, you will complete:

    • Questionnaires about your medical history and physical and mental health. If your initial evaluation is at an NPN clinic, your NPN case manager will call you before your appointment to get your medical history;
    • An assessment of your 9/11 exposure;
    • Blood tests;
    • A physical exam;
    • Breathing tests (spirometry/pulmonary function testing); and
    • A vital signs check (blood pressure, body temperature, respiration rate, and heart rate).

    If you meet certain guidelines and your doctor thinks it is medically necessary, you may also have:

    • A chest X-ray;
    • An EKG;
    • Urine testing.

    If the evaluation suggests you may have a WTC-related health condition, the condition will have to be certified before the Program can cover treatment (see What is certification? in this FAQ for more information).

  • How can I prepare for my initial health evaluation?

    To get the most out of your evaluation:

    • Review the member handbook to learn about your Program benefits, rights, and responsibilities;
    • Complete any paperwork provided by your Program clinic prior to your first visit;
    • Write down a list of symptoms you are experiencing, even those that you think might not be related to your 9/11 exposures. Symptoms may include trouble sleeping, persistent cough, runny nose, etc.;
    • Write down a list of questions you would like to ask the doctor, mental health provider, or benefits counselor;
    • Write down a list of any medications you are currently taking;
    • Bring your medical records and any workers’ compensation or line-of-duty injury paperwork with you; and
    • Be prepared to talk about your exposure, work history (if applicable), and your current symptoms.
    • Survivors: present your primary insurance card at ALL appointments.
  • How do I request copies of my medical records from my WTC Health Program clinic?

    Your Program provider will need a HIPAA Authorization to Disclose Health Information form from you before they can release copies of your medical records. Please contact your CCE/NPN to get this form and find out how to return the completed form to them.

    You can find contact information for each clinic on the Find a Clinic page.

  • Can I change clinics?

    Yes, but different clinics see different types of members. Responders need to go to Responder clinics, and Survivors need to go to Survivor clinics. You can find the right kind of clinic for you on the Find a Clinic page.

    To transfer clinics, contact your current CCE or NPN. That clinic will start the transfer process. You will need to sign a medical release form so your old clinic can send your records to the new one.

    You can choose to transfer to a new clinic once every 12 months. If you move, you can transfer to a new clinic immediately even if you transferred within the last 12 months. If you have special circumstances that mean you need to transfer more than once in 12 months, contact your clinic and explain the circumstances.

    Learn more about the transfer policy and process on the Transferring Clinics page.

  • Can I be seen at more than one WTC Health Program clinic at a time?

    No. To maintain continuity of care, you must receive your Program health benefits through one Program clinic (or the NPN) at a time.

  • If I have a health condition and I am already seeing a doctor for my care, can I keep seeing the same doctor?

    For the WTC Health Program to cover your treatment, your condition must be certified, and you must be treated by a provider affiliated with the Program. If your current doctor is affiliated with the Program, you can continue seeing the same doctor for your certified condition.

    If your current doctor is not affiliated with the Program, they may be eligible to become a Program doctor. Ask your doctor to contact your Program clinic to discuss the requirements.

  • What health conditions does the WTC Health Program cover?

    By law, the Program covers treatment for only specific physical and mental health conditions related to 9/11 exposures. The List of WTC-Related Health Conditions may be updated through rulemaking based on available science. Your provider will work with you to find out if your health condition or conditions are covered.

    There are five categories of conditions that the Program covers:

    • Acute traumatic injuries (like burns, sprains, and fractures)
    • Aerodigestive (airways and digestive) disorders (like asthma, GERD, and sleep apnea)
    • Certain cancers
    • Mental health conditions (like PTSD, depression, and substance abuse)
    • Musculoskeletal disorders (like carpal tunnel syndrome and low back pain)

    For more detailed information on the conditions covered under each category, please see the Covered Conditions page of the Program’s website. Please note, however, that not every condition falling under these categories is covered by the Program. Please see the Program Regulation at 42 C.F.R. § 88.15 for the official List of WTC-Related Health Conditions (List).

    In order for the Program to cover treatment for your condition, your condition has to be on the List and also has to be certified by the Program as a WTC-related health condition. See What is certification? for more details.

  • What does it mean for my condition to be covered by the WTC Health Program?

    The WTC Health Program covers medically necessary monitoring and treatment for certified WTC-related health conditions. The Program also covers medically associated health conditions, which are conditions that result directly from the treatment or progression of a certified condition. For example, the Program does not cover routine dental care; however, if a member has a certified WTC-related head and neck cancer and the Program determines that treatment for that cancer has resulted in a dental condition, the Program may certify the dental condition as a medically associated condition and cover medically necessary dental procedures to treat the certified medically associated dental condition.

    “Medically necessary” means the treatment has been shown to manage, improve, or cure your health condition or an illness caused by your condition.

    The Program covers medically necessary treatment for certified conditions when such treatment complies with all Program policies, procedures, and medical protocols. There may be quantity or frequency limits for some treatments.

  • What if my evaluation finds a health condition that is not covered by the WTC Health Program?

    The Program can cover treatment only for health conditions on the List of WTC-Related Health Conditions (List) that are also certified as related to your specific 9/11 exposures. If your condition is not on the List, or if the type of health condition you have is on the List but does not meet the requirements for certification, your provider will refer you to a benefits counselor. The counselor can help you find options for treatment of your condition outside the Program.

  • What is certification?

    The WTC Health Program will pay for medically necessary treatment of certified conditions. The Program can certify your condition if:

    • Your health condition is included on the List of WTC-Related Health Conditions;
    • Your 9/11 exposures are substantially likely to have been a significant factor in aggravating, contributing to, or causing the health condition; and Your health condition and 9/11 exposures meet WTC Health Program policies and criteria for certification, such as maximum time intervals, minimum latency requirements, or any additional requirements.

    If your WTC Health Program doctor determines that you have a health condition that meets all of the criteria above, your CCE or the NPN will complete paperwork signed by your Program doctor (called the WTC-3 Certification Package) to request that the Program certify your health condition.

    The Program will review the WTC-3 Certification Package submitted by your CCE or the NPN to decide if your health condition can be certified. The Program will certify your health condition if it finds that your health condition and exposure meet the above criteria.

    To learn more about the certification policies and certification criteria, visit the WTC Health Program Policies and Procedures page.

  • How will I find out if my condition has been certified?

    The WTC Health Program will notify you in writing if your condition has been certified or denied certification. Your CCE or NPN will also be sent notification of the decision.

    Call the WTC Health Program helpline at 1-888-982-4748, Monday through Friday, 9 a.m. to 5 p.m. (Eastern), to check the status.

  • How soon after certification can I get treatment?

    You’re eligible for treatment in the WTC Health Program as soon as your condition has been certified. Your provider will work with you to set up a treatment schedule.

  • If my condition is denied certification, what can I do?

    If your CCE or NPN doctor submits a certification request and the WTC Health Program denies certification of your health condition, you have the right to appeal that decision. Please see the Appeals section for more information. You will be informed of the denial in writing and receive information about how to appeal the denial at that time.

    View Appeals FAQs to learn more.

  • What options do I have if my condition is not submitted to the WTC Health Program for certification?

    If your CCE or NPN provider declines to submit your health condition to the Program for certification, you may be eligible for a secondary medical review. A secondary medical review is a review of your case by the CCE/NPN Clinical Director or a designee. This designee may be a WTC Health Program doctor at another CCE.

    You may request a secondary medical review when, for example, you disagree with the CCE/NPN doctor regarding the characterization of your exposure, diagnosis, onset of symptoms date(s), or intensity of exposure in relation to aggravating, contributing to, or causing your health condition.

    However, you may not request a secondary medical review when your health condition does not meet Program policy or certification criteria. Disagreement with Program policy is not a valid reason for secondary review.

    If your condition is not submitted to the Program for certification because it is not on the List of WTC-Related Health Conditions, you can petition to have your health condition added. Learn more about petition process at the Petition page.

    If you are not eligible for a secondary medical review and still have concerns regarding your health condition and certification, you may write to the Administrator of the WTC Health Program at:

    World Trade Center Health Program
    National Institute for Occupational Safety and Health
    395 E Street, S.W.
    Suite 9200
    Washington, DC 20201

  • What if my condition is not on the List of WTC-Related Health Conditions, but my provider thinks it is WTC-related?

    The Program only provides treatment for the specific conditions on the List of WTC-Related Health Conditions established by the Zadroga Act and Program regulations. However, the Administrator may add new health conditions to the List through the rulemaking process.

    For example, a condition may be added if the Administrator finds there is enough scientific evidence to link a health condition to 9/11 exposures. This might happen if research shows that a health condition is more likely to occur in individuals with 9/11 exposure than in individuals without 9/11 exposure.

    You may have a condition that you believe is the result of your 9/11 exposure but is not included on the List. If this is the case, you may petition the Administrator to add a health condition to the List. In order to be considered, a petition must be sent in writing to the Administrator, and include the following:

    • An explicit statement of an intent to petition the Administrator to add a health condition to the List of WTC-Related Health Conditions;
    • Name, contact information, and signature of the interested party submitting the petition;
    • Name and description of the health conditions(s) to be added; and
    • Reasons for adding the health conditions(s), including the medical basis for the association between 9/11 exposure and the health condition(s) to be added.

    Please see visit the Petitions page for more information on submitting a petition to add health conditions to the List.

  • What treatment services are available in the WTC Health Program?

    The Program pays for all medically necessary treatment for your certified WTC-related health condition(s), as well as any certified medically associated health condition(s), as long as treatment is provided by a WTC Health Program affiliated provider. All Program treatment services must be authorized by your Program provider, and in some cases the CCE or NPN Clinical Director and the Program. All treatment must follow Program guidelines. To learn more about treatment in the Program, see the Treatment section of the Member Handbook.

  • Should I schedule a monitoring exam even if I am feeling well?

    Yes. Members eligible for medical monitoring within the WTC Health Program are strongly encouraged to participate in regular monitoring exams for the following two reasons:

    1. The exam may detect changes in body function that you are not aware of and that can be corrected or slowed with early intervention; and
    2. While the main focus of the WTC Health Program is to assess your health, the information that is learned about 9/11 responders is extremely valuable in understanding how to protect workers in future emergency or disaster operations.

Cancer in the WTC Health Program

  • What cancers are covered by the WTC Health Program?

    The Program covers a wide variety of cancers. Further description of the cancers covered by the Program may be found on the Program’s Covered Conditions webpage. The official list of WTC-related cancers can be found in the Program’s regulation at 42 C.F.R. § 88.15, List of WTC-Related Health Conditions in the cancer section. If you have cancer, speak to your CCE or NPN doctor to find out if your cancer may be related to your 9/11 exposure. In order for your cancer to be certified it must meet certain criteria like cancer latency periods. Visit the cancer latency section of the member handbook to learn more about cancer latency periods.

    To learn more about certification visit the Certification section of this FAQ.

  • If I have one of the cancers on the list, am I automatically eligible for treatment coverage in the WTC Health Program?

    No. The inclusion of your cancer on the List of WTC-Related Health Conditions does not mean that your cancer will automatically be covered by the Program. Your Program doctor must also find that your 9/11 exposures are substantially likely to have been a significant factor in causing or contributing to your cancer and request certification of your cancer from the Program. If your cancer is certified, then you are eligible for treatment coverage in the Program.

  • If I have cancer and I am already seeing a doctor for my cancer care, can I still keep seeing my current doctor?

    In order for a WTC Health Program member to obtain coverage for treatment of any health condition on the List of WTC-Related Health Conditions (List), including any type of cancer added to the List, the condition must first be certified by the Program.

    Once certified, all care must be rendered by a provider affiliated with the Program. If your current doctor is affiliated with the Program, then you will be able to continue seeing your doctor. If your current provider is not affiliated, ask the provider to contact your CCE or the NPN to discuss becoming a WTC Health Program provider.

  • Will the WTC Health Program provide reimbursements to individuals for cancer treatment costs incurred before coverage began in the Program (October 2012) or before certification?

    No. The Program will not reimburse members or healthcare providers for the costs of cancer treatments received before cancer coverage began in the Program (October 2012) or before certification.

    However, you may be able to receive compensation through the September 11th Victim Compensation Fund (VCF) for past cancer treatment costs. The VCF is administered by the Department of Justice, and enrollment in that program is separate from the WTC Health Program.

    For information regarding the VCF, please visit https://www.vcf.gov/ or call the VCF toll-free at 1-855-885-1555.

  • I have cancer now. What should I do?

    If you are a member of the WTC Health Program:

    Contact your Clinical Center of Excellence (CCE) or the Nationwide Provider Network (NPN) to schedule an appointment so that you can begin the cancer certification process as soon as possible. If you do not know which CCE/NPN you are with, please contact the Program helpline at 1-888-982-4748, Monday through Friday, 9 a.m. to 5 p.m. (Eastern).

    If you are not a member of the WTC Health Program:

    Please visit our How to Apply page for information about the application process. You can also contact the Program at 1-888-982-4748 for information on how to apply.

  • I don’t have cancer now, but I have had cancer since September 11, 2001. What should I do?

    If you are a member of the WTC Health Program:

    Contact your CCE or NPN to schedule an appointment to review your medical history. Your doctor will determine if the cancer certification process should be started in case you need treatment again in the future. If you do not know which CCE/NPN you are with, please contact the Program helpline at 1-888-982-4748.

    If you are not a member of the WTC Health Program:

    Please visit our How to Apply page for information about the application process. You can also contact the Program at 1-888-982-4748 for information on how to apply.

  • I don’t have cancer now, but what if I get it in the future? What should I do then?

    If you are a member of the WTC Health Program:

    It is important that you continue to go to your annual monitoring exams so that your health can be checked. If a doctor finds that you have cancer, or any other listed WTC-related health condition, during your annual monitoring exam, the doctor will determine whether your health condition may be related to your 9/11 exposure. If your Program provider determines your cancer is related to your 9/11 exposures, your provider will request certification of that condition(s) as soon as possible so that you can get the treatment you need.

    At any point in time, if you find out you have cancer from another healthcare provider, contact your CCE or NPN as soon as possible so that your doctor can determine if the certification process should be started.

    If you are not a member of the WTC Health Program:

    If you are eligible as a Responder, you should apply and begin your annual monitoring exams so that your health can be checked yearly to see if you develop any WTC-related health conditions, including cancer.

    If you are eligible as a Survivor and develop a condition (or symptoms of a condition) on the List of WTC-Related Health Conditions, including cancer, you should then apply to the WTC Health Program.

    For more information, see the How to Apply page.

  • What if I want to be screened for cancer?

    Responders and certified-eligible survivors are eligible for breast, cervical, colon, and lung cancer screening as necessary according to the U.S. Preventive Services Task Force (USPSTF) guidelines. Screening may have to comply with frequency limits and age requirements.

Pharmacy Benefits

  • If I need medications for my certified health condition, how can I get them?

    You can either have your prescription medications delivered to your home by mail order or pick them up from your local in-network pharmacy.

    Optum, the Pharmacy Benefits Manager for the WTC Health Program, has two home-delivery (mail-order) services:

    • The OptumRx service fills non-specialty prescriptions.
    • The OptumRx Specialty Pharmacy (formerly known as BrivoaRx) service fills specialty prescriptions that need special handling (like refrigerated shipping) or administration (like infusion).

    If you want to enroll in home delivery, or if you need help getting home-delivery refills, you can call Optum at the number on your pharmacy card (1-855-640-0005, option #2) to speak with a customer service representative. You can also visit enroll or request refills on Optum’s WTC Health Program Home Delivery website.

    To find a local in-network pharmacy, you can use Optum’s Pharmacy Locator.

    For more information, visit the Pharmacy Benefits page.

  • Do I have to pay anything for prescriptions or home delivery?

    No, the Program pays for medications approved for your certified WTC-related health condition(s), whether you get them from your local in-network pharmacy or by home delivery.

  • If I pay out-of-pocket for my prescription, can the WTC Health Program reimburse me?

    No, the Program can’t make payments to individual members, so it is important to use your Program pharmacy benefits when you get your prescriptions.

    For Survivors, your primary, individual health insurance (private and/or public) must pay their share of the prescription cost first, then the Program pays the rest. This is known as Coordination of Benefits and is a process required by the Zadroga Act. Learn more about this process in the Coordination of Benefits section of the member handbook. For more information on how to ensure your prescriptions are billed correctly at a retail pharmacy, visit the Coordination of Benefits page.

  • How do I know which medications are covered by the Program?

    The Program covers medically necessary prescription drugs used to treat a certified WTC-related health condition. Your Program doctor or specialist will prescribe medication for you using the Program’s formulary, a list of drugs approved by the Program.

    On occasion, you may need a medication that is not on the approved formulary. Your Program doctor can submit a request to the Program for approval to prescribe a drug for you that is not on the Program’s formulary.

    Program medical staff will review the request from your Program doctor and decide if the drug should be approved. If the drug is approved, the medication will be covered by the Program at no cost to you. Non-formulary drugs can be approved for up to 1 year.

    If the drug is not approved but you would like to continue using it, you will have to use a different form of payment such as your primary insurance or pay out of pocket for the drug.

  • Will I get a pharmacy card from the Program?

    Members with certified health conditions will receive an Optum pharmacy card. If you did not receive an Optum card, or have questions about your pharmacy benefits, please call Optum at 1-855- 640-0005 or contact your CCE.

    For members in the NPN, pharmacy information is printed on the NPN cards sent by LHI. However, only those NPN members with a certified WTC-related health condition(s) receive NPN cards. If you have questions about NPN member cards, please call LHI at 1-877-498-2911 or contact them through the LHI.Care Member Portal.

Appeals

  • When can I file an appeal?

    You or your designated representative may appeal the following three types of decisions made by the Program:

    • Enrollment denial – includes denial of enrollment in the Program or disenrollment.
    • Certification denial – includes denial of certification of a health condition as a WTC-related health condition, denial of certification of a health condition as a medically associated health condition, or decertification of a WTC-related health condition.
    • Treatment denial - includes denial of treatment authorization for a certified health condition based on a finding that the treatment is not medically necessary.

    Not all appeal requests can be considered. An appeal will be considered invalid if it challenges:

    • Enrollment criteria established by the James Zadroga 9/11 Health and Compensation Act (Zadroga Act) or WTC Health Program regulations;
    • Certification requirements established by the Zadroga Act;
    • A WTC Health Program policy that has been established by the Administrator and is applicable to all Program applications and/or members; or
    • The exclusion or absence of a health condition from the List of WTC-Related Health Conditions (List).

    Criteria and requirements in the Zadroga Act are established by law and may only be changed by the U.S. Congress amending the Act. Criteria within the WTC Health Program’s regulations are established through rulemaking and may only be changed by the Program revising the regulations. Health conditions may only be added to the List through a petition process. More information on how to add a condition available on the Petitions page.

    Your appeal may, however, challenge the Program’s application of enrollment, certification, or treatment authorization criteria to your individual enrollment, certification, or treatment decision. For example, an appeal request could argue that the Program incorrectly determined the number of hours the individual worked or volunteered during a covered time period.

    More information on what may and may not be appealed is available on the Appeals page.

  • How do I file an appeal?

    If you would like to appeal an enrollment, certification, or treatment denial, you must mail or fax a written letter requesting an appeal to the Program’s appeals coordinator postmarked within 120 calendar days from the date of your denial/disenrollment/decertification letter from the Administrator.

    Your appeal letter must:

    • Be made in writing and signed;
    • Identify the name, address, and contact information of the member and designated representative (if applicable);
    • Describe the decision being appealed and state the reasons why you believe the decision was incorrect and should be reversed; and
    • Provide a basis for the appeal that is sufficiently detailed and supported by information to permit a review of the appeal. An appeal request may include relevant new information not previously considered by the WTC Health Program.

    The description may include:

    • Scientific or medical information correcting factual errors that may have been submitted to the Program by the CCE or NPN;
    • Information showing that the Program did not correctly follow or apply relevant Program policies or procedures;
    • Any information showing that the Program’s decision was not reasonable given the facts of the case; or
    • A request to designate a representative.

    Your appeal letter should be mailed or faxed to:

    Appeals Coordinator WTC Health Program
    P.O. Box 7000
    Rensselaer, NY 12144
    Fax: 1-877-646-5308

    For certification denial, decertification, or treatment authorization denial appeals, your appeal request may also include a request for you or your designated representative to make a 15-minute oral statement by telephone.

    For more information on filing an appeal visit the Appeals page.

Workers' Compensation Lump-Sum Settlements

  • How do workers’ compensation lump-sum settlements work with the WTC Health Program?

    Where your health condition it work-related, the James Zadroga 9/11 Health and Compensation Act requires the WTC Health Program to recoup (recover) costs from workers’ compensation insurers since these insurers have primary responsibility for your healthcare expenses.

    If you receive a lump-sum settlement from workers’ compensation for a health condition that would be covered by the Program, you will need to set some of that money aside for future medical expenses in the Program. The Program must approve the amount of this set-aside. The Program will bill the set-aside account periodically, to recoup the costs of your treatment. It will not bill the set-aside account more than the total amount approved.

  • Does the WTC Health Program have to approve my lump-sum settlement agreement from workers’ compensation?

    The Program has to approve all lump-sum workers’ compensation agreements settled on or after October 1, 2013.

    If your settlement agreement releases your employer or insurer from future payments towards health conditions that are covered by the Program, and workers’ compensation would otherwise have paid for those conditions, then the Program must approve the amount of money you set aside to pay for future medical expenses before you agree to the settlement. The Program will bill the set-aside account periodically, to recoup the costs of your treatment. It will not bill the set-aside account more than the total amount approved.

    You do not need Program approval for any settlements filed with workers’ compensation before October 1, 2013, even if workers’ compensation approved the settlement after that date.

  • How much of my settlement do I have to set aside for future medical expenses?

    You need to set aside enough to pay for the reasonably anticipated costs of medical treatment and medications for your covered conditions. Since Congress has funded the WTC Health Program through 2090, you should set aside enough to pay for future medical expenses for your health conditions covered by the Program through 2090, taking into account your anticipated lifetime. You should use the reimbursement rates under your state’s workers’ compensation law to calculate those costs.

    You do not have to set aside money for screenings, monitoring exams, or diagnostic testing provided by the Program.

    The Centers for Medicare and Medicaid Services (CMS) have their own requirements for lump-sum settlements. To find out if you have comply with CMS requirements as well as WTC Health Program requirements, visit the Workers’ Compensation Medicare Set Aside Arrangements page on CMS’ website.

  • How do I get approval from the WTC Health Program for a set-aside arrangement?

    You or your designated representative need to submit a copy of the proposed settlement agreement to the Program. The proposed agreement has to show:

    • Your (the claimant’s) name, address, and date of birth;
    • The Workers’ Compensation Board claim number;
    • A description of the conditions covered by workers’ compensation, and whether the Workers’ Compensation Board has ordered the carrier (the insurance company) to pay medical benefits (or whether the carrier’s responsibility for medical benefits is still in dispute);
    • A statement about any proposals to set aside money from your lump-sum settlement, including the amount you plan to set aside;
    • An explanation of how you calculated your future medical and pharmaceutical expenses. If the amount is based on an actuarial estimate from an outside expert, send the expert’s report too;
    • A copy of the CMS approval of any Medicare set-aside, if CMS has reviewed the settlement; and
    • The name and address of the custodian for the set-aside funds. The custodian is the individual or entity who will pay any medical expenses on your (the claimant’s) behalf. You can be the custodian for your own fund, or you can choose someone else to manage the account.

    Send all the information above to the WTC Health Program at wtchp.recoup@cdc.gov.

  • How will I know whether the WTC Health Program has approved the set-aside?

    The Program will send a letter telling you whether the Program agrees that the amount set aside for future medical expenses is reasonable, or whether you do not have to set aside any money from your lump-sum settlement.

    The Program will bill the set-aside account periodically, to recoup the costs of your treatment. It will not bill the set-aside account more than the total amount approved.

  • What happens if the WTC Health Program doesn’t approve my proposed set-aside?

    If you don’t get the Program’s approval for a set-aside amount to pay for a health condition covered by the WTC Health Program from your lump-sum settlement, you may be legally responsible for future medical expenses in the Program. The Zadroga Act requires the Program to recoup (recover) costs for conditions that are covered under other programs, like Workers’ Compensation. If you receive a settlement that releases your workers’ compensation insurer or employer from legal responsibility for future medical expenses, and the Program has not approved the settlement, the Program may need to recoup those costs directly from you.

  • What happens if the money I set aside is not enough to cover all future medical expenses?

    You will not have to pay for any medical expenses within the WTC Health Program beyond the set-aside amount, as long as the Program approved the amount of money set aside for future medical expenses and you created a set-aside account with the approved amount.

    The Program will bill the set-aside account periodically, to recoup the costs of your treatment. It will not bill the set-aside account more than the total amount approved. If your medical expenses are more than the amount in your approved set-aside agreement, the Program will pay those extra expenses.