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 on the Coordination of Benefits page.
WTC Health Program members should not receive bills or be asked to pay any copays for treatment of their certified WTC-related health condition(s). However, if you are asked for a copay or do receive a bill by mistake, please call your Clinical Center of Excellence or the Nationwide Provider Network as soon as possible to alert them to the problem.
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.