Final

Issued by: Centers for Disease Control and Prevention (CDC)

Overview of the WTC Health Program

WTC Health Program Values

Convenient Care

The WTC Health Program (the Program) provides care at multiple Clinical Center of Excellence (CCE) locations throughout the New York (NY) Metropolitan Area. There are specific CCEs for WTC Responders and WTC Survivors. You can find a complete list of CCE locations on page 19.

The Nationwide Provider Network (NPN) provides care for WTC Responders and WTC Survivors who live outside of the NY Metropolitan Area. The Program was specifically set up this way so that it would be convenient for you to access care near your residence or place of work. In the event that you move and need to locate medical providers close to your new residence the NPN allows you to continue receiving care in the Program.

Competent Care

The Program’s CCEs care for thousands of WTC Responders and WTC Survivors. Program medical and mental health providers are experts with special skills in the diagnosis and treatment of WTC-related physical and mental health conditions.

Comprehensive Care

The Program offers services to help you with your medical, mental health, and benefits needs related to your certified WTC-related health conditions. We recognize that illness not only affects your body, but also your mind, your work, your relationships, and your finances. Our staff experts work together to deliver comprehensive care so that you can address all of these related needs. A List of the WTC-Related Health Conditions (List) can be found in the Certifications and Covered Conditions section.

Compassionate Care

Because we have cared for tens of thousands of WTC Responders and WTC Survivors, we are familiar with and sensitive to how your experience may continue to affect you today. The Program offers a safe space to talk about what happened on 9/11 and how it might still affect you, your family, and your work.

Complementary Care

Through the James Zadroga 9/11 Health and Compensation Act of 2010 (Zadroga Act) and its reauthorization, we are able to provide medical and mental health services at no cost to you. This means that you can access convenient, competent, comprehensive, and compassionate care without having to pay any co-payments, deductibles, or other out-of-pocket expenses for medically necessary treatment of your certified WTC-related health conditions.

The James Zadroga 9/11 Health and Compensation Act of 2010

The James Zadroga 9/11 Health and Compensation Act of 2010 (Zadroga Act) addresses the following three programs that help those directly affected by the September 11th terrorist attacks:

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

On December 18, 2015, President Barack Obama signed legislation to reauthorize the Program. The law extended the program for 75 years, until 2090.

WTC Health Program

The Zadroga Act established the WTC Health Program to serve two categories of individuals:

1. WTC Responders: FDNY Responders and family members; General NYC Responders (a person who worked or volunteered in rescue, recovery, demolition, debris cleanup, and/or other related support services in response to the September 11, 2001 terrorist attacks in New York City (NYC)); Responders at the Pentagon; and Responders in Shanksville, Pennsylvania.
2. WTC Survivors: individuals who were present in the New York City (NYC) Disaster Area in the dust or dust cloud on September 11, 2001; who worked, resided, or attended school, childcare, or adult daycare in the NYC Disaster Area during or following the September 11, 2001 terrorist attacks; who were eligible for certain residential grants; or whose place of employment was eligible for certain grants following the September 11, 2001 terrorist attacks.

The Program is a limited health care program that provides the following services to Responders and Survivors

Enrolled Responders receive:

• Annual monitoring exams.

Enrolled Screening-Eligible Survivors receive:

• A one-time initial health evaluation.*

*If the initial health evaluation does not result in any certifications and the Survivor later feels a new health problem may by WTC-related, he or she can pay out of pocket for an additional health evaluation by a Program doctor.

Enrolled Responders and Certified-Eligible Survivors receive:

• Annual monitoring exams;
• Medical and mental health treatment for covered WTC-related health conditions; and
• Benefits counseling services.

This handbook will provide you with detailed information about these services as well as your benefits, rights, and responsibilities as a member of the Program.

September 11th Victim Compensation Fund (VCF)

The Zadroga Act also reopened the September 11th Victim Compensation Fund (VCF) administered by the U.S. Department of Justice. The VCF provides compensation to any individual (or a personal representative of a deceased individual) who suffers from physical conditions or injuries sustained as a result of the September 11th terrorist attacks or the debris removal efforts that took place in the immediate aftermath. The Fund does not compensate for mental health conditions related to 9/11 exposures. You may be eligible for compensation through the VCF.

Please note, the VCF is a separate program from the WTC Health Program. It is a compensation program administered by the U.S. Department of Justice and does NOT provide health care. Enrollment in the WTC Health Program does not automatically enroll you in the VCF.

For more information about the VCF, including whether or not you might be eligible, please contact the VCF directly at www.vcf.gov or 1-855-885-1555.

WTC Health Registry

The Zadroga Act also extended the WTC Health Registry (Registry). The Registry was developed to document and evaluate the long-term physical and mental health effects of the September 11, 2001 terrorist attacks. To date, the Registry is the largest effort in the U.S. to monitor the health of people exposed to a large-scale disaster. Enrollment in the Registry occurred in 2003-2004 through voluntary response to a survey and is now closed.

The results of the first and follow-up surveys will help determine to what extent physical and mental health conditions have persisted in 9/11-exposed populations, and whether any new symptoms and conditions have emerged. Another important goal of the Registry is to identify and help address gaps in physical and mental health treatment in these populations.

For more information about the WTC Health Registry, please contact the WTC Health Registry directly at wtchr@health.nyc.gov. You can also visit www.nyc.gov/9-11health or call 1-866-692-9827.

Program Information

The Program covers initial health evaluations, annual monitoring exams, and medically necessary medical and mental health treatment for certified WTC-related health conditions. For the List of conditions that may be certified by the Program, see covered conditions on page 29.”

The program is not meant to be a replacement for your health insurance. You must use your public or private health insurance or pay out of pocket for any treatment for a health condition not certified by the Program. You are responsible for bills from your providers or health insurance for all health conditions not certified by the Program.

For Responders: The Program is the first payer for all monitoring and treatment of a certified WTC related health condition, unless the responder has a workers’ compensation claim for the certified condition.

For Survivors: For Certified-Eligible Survivors, the Program is the last payer of your monitoring, treatment, and medication. The Program will bill your private insurance first, then any public insurance you may have, and then the Program will cover all additional costs for the treatment and medications for your certified WTC-related health conditions. These services are still offered at no cost to you because you will not be responsible for paying any co-insurance charges, copayments, or deductibles for care of your certified WTC-related health conditions (so long as you see a Program doctor).

Insurance

The Zadroga Act requires all Program members to have qualifying health insurance unless they meet one of the exceptions in the Affordable Care Act.

Your CCE or the NPN can advise you about how to find care outside of the Program for any health conditions not certified by the Program. You, or your primary health insurance plan, will have to pay for care received outside of the Program. If you do not have insurance, your Program doctor will refer you to a staff person who can help you determine if you might be eligible for public health insurance programs like Medicaid or Medicare. If not, a staff person can help you to get the care you need at a federally qualified health center, or other community health center, that offers more affordable care options for you.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.