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The Importance of Having a WillLODA-eligible employees and volunteers should keep their wills up to date, to ensure the death benefitpayment is made according to their wishes. Otherwise, the order of precedence will determine whoreceives the death benefit.Order of Precedence*LODA Health BenefitsGenerally, if there is no will, the death benefitis made according to the order of precedencedetailed below.In addition to the one-time benefit payment,eligible surviving family members maycontinue health plan coverage in the LODAHealth Benefits Plans, administered byDHRM. If the LODA death benefit claim isapproved, VRS will mail the letter of approvalto the eligible family members. DHRMwill provide approved claimants with anapplication for health plan enrollment. Pleasesee Section 4 for additional details on LODAhealth benefits. If no spouse, to the LODA-eligibleindividual’s children and theirdescendants; If none of the above, to the LODA-eligibleindividual’s parents equally or to thesurviving parent; If none of the above, to the LODA-eligibleindividual’s brothers and sisters and theirdescendants; If none of the above, to the LODA-eligibleindividual’s maternal and paternal next ofkin as provided by law; and If none of the above, to the family of theLODA-eligible individual’s most recentspouse, provided that the individual andthe most recent spouse were married atthe time of the most recent spouse’s death.Funeral ExpensesThe beneficiary or beneficiaries may requestbenefits to pay funeral expenses (burial andtransportation) to the funeral service provider,as an advance of the death benefit payment.The total death benefit payment will bedecreased by the funeral expense amount. If aclaimant’s claim is later denied, the claimantmust return the funeral expense advance.* Generally, payment will be made in this order. However, payment may deviate from this orderin certain circumstances. For instance, if the deceased has children outside of his or her currentmarriage, payment will be made to all children and to the current spouse.9 LINE OF DUTY ACT PARTICIPANT GUIDE First, to the LODA-eligible individual’sspouse;

3. In the Event of DisabilityIf you are determined by VRS to be disabledin the line of duty, you and your eligiblefamily members may continue health plancoverage through enrollment in the LODAHealth Benefits Plans administered byDHRM.Applying forLODA Disability BenefitsTo start the claim for LODA disability, VRSmust receive the claim form included at theend of this guide. The Claim for Line of DutyAct (LODA) Benefits contains instructions forcompleting the form and returning it to VRS.For an overview of the claims process, viewthe tutorial, How to Apply for LODA Benefits,at valoda.org/claims, and see Section 6 of thisguide.If the LODA disability claim is approved, VRSwill mail a letter of approval to the LODAeligible person and eligible family members.DHRM will provide approved claimants withan application for health plan enrollment.See Section 4 for additional details on LODAhealth benefits.Disability RequirementsFor LODA benefits to be approved, thedisability must be the result of a physicalillness or injury or a cognitive condition thatoccurred in the line of duty and that is likelyto be permanent. The physical illness or injuryor cognitive condition must prevent you fromfurther performing your duties in the LODAeligible position.Working and LODA DisabilityBenefitsBefore accepting part-time or full-timeemployment, the approved claimant mustnotify VRS to determine the impact of takingthe position on LODA benefits.LODA ReevaluationBe aware that VRS may reevaluate eligibilityfor the LODA disability benefit at any time.Failure to comply with a reevaluation willresult in suspension or loss of benefits.Presumption10 VALODA.ORG 888-827-3847To qualify for LODA benefits, the death or disability must have occurred “in the line of duty.” If thedeath or disability did not occur directly on the job but as a result of job-related factors, there may be apresumption that the disability or death occurred in the line of duty.Example: A firefighter develops lung cancer and becomes disabled. The lung cancer is not attributableto any one incident on the job, but rather years of exposure to smoke while fighting fires. Although anidentifiable incident did not occur during work hours, there may be a presumption that the lung canceroccurred in the line of duty.

4. About LODA Health CoverageLODA Health Benefits Plans are administeredby DHRM, are modeled after State EmployeeHealth Benefits Program plans, and provideconsistent, premium-free continued healthplan coverage for LODA-eligible disabledpersons, survivors and qualified familymembers.Children reaching age 26:LODA-eligible children will lose eligibilityfor LODA Health Benefits Plans coverage atthe end of the year in which they reach age26 unless they meet the requirements to becovered as an adult incapacitated dependentchild.Medicare eligibility due to age:The claimant(s) must meet eligibilityrequirements for the LODA Health BenefitsPlans as defined in the Line of Duty Act.Following are some events that could affecteligibility:LODA Health Benefits Plans participantswhose eligibility is based on death ordisability on or after July 1, 2017, will losecoverage when they become eligible forMedicare due to age. This does not apply tothose whose LODA eligibility is based ondeath or disability prior to July 1, 2017.Change in marital status:Return to full duty: Spouses of disabled persons whosemarriage occurs after the date of LODAdisability are not eligible for LODA HealthBenefit Plans coverage.LODA-disabled persons and their coveredfamily members will lose eligibility for theLODA Health Benefits Plans if the disabledperson returns to full duty in any position asdefined in the Code of Virginia § 9.1-400.Ongoing Eligibility LODA-eligible surviving spouses whoremarry on or after July 1, 2017, will loseeligibility for LODA Health Benefits Planscoverage. (Remarriage prior to July 1, 2017,will not result in loss of LODA coverage.)Upon remarriage of the surviving spouse,eligible dependent children may continuecoverage if they remain otherwise eligibleunder LODA provisions. Divorce.Newborn or newly-adopted children:Children conceived or adopted by a LODAdisabled person after the date of disabilityare not eligible for LODA Health BenefitsPlans coverage. However, children born oradopted after an eligible employee’s death ordisability, but before July 1, 2017, are eligiblefor LODA Health Benefits Plans coverage, asadministered by the Department of HumanResource Management.Salary increases above earningsat the time of disability:Disabled persons and their family memberscovered under the LODA Health BenefitsPlans will lose eligibility for coverage if thedisabled person’s annual earned incomebecomes equal to or greater than their salaryat the time of disability (indexed for inflation).Coverage can be reinstated if the disabledperson’s annual salary drops below theirincome at the time of disability. Additionalinformation will provided at the time ofenrollment.Note: It is the responsibility of the LODA HealthBenefits Plans participants to email DHRM(loda@dhrm.virginia.gov) when these eventsoccur.11 LINE OF DUTY ACT PARTICIPANT GUIDELODA Health Benefits Plans

Health Insurance Credit EligibilityThe health insurance credit is provided toeligible VRS retirees for reimbursement ofhealth premium expenses. If you receivethe VRS health insurance credit and areapproved for the LODA Health BenefitsPlans, the credit will not be provided to yousince you will no longer pay premiums forhealth coverage under LODA.Health Insurance ReimbursementIf a claim is approved, there may bereimbursement of the health insurancepremiums paid during the period when theclaim was under consideration, dating backto the date when the disabled or deceasedemployee or volunteer was no longer eligiblefor employer-subsidized health insuranceMore Informationcoverage. Your health insurance premiumis employer-subsidized if your employerpays any portion of the premium amount.Only those who incurred costs for paymentof out-of-pocket health premium amountsnot subsidized by the employer duringthe claims review process are eligible forreimbursement. If the approved claim is fromemployment with a LODA Fundparticipating employer, then VRS willreimburse the health insurance cost fromthe LODA Fund. If the approved claim is fromemployment with an employer that doesnot participate in the LODA Fund, thenVRS will notify the employer to reimbursethe claimant for these expenses.12 VALODA.ORG 888-827-3847For more information regarding LODA Health Benefits Plans coverage, contact DHRMat loda@dhrm.virginia.gov or visit the DHRM website, ts, where you’ll find frequently asked questions and answers as well as other resources aboutthe LODA Health Benefits Plans. You also may call 888-642-4414 for assistance.

5. Other BenefitsFederal BenefitsOther VRS BenefitsThe Federal Public Safety Officers’ BenefitAct provides death and education benefits tosurvivors of fallen law enforcement officers,firefighters and other first responders, anddisability benefits to officers catastrophicallyinjured in the line of duty. For moreinformation, contact the Bureau of JusticeAssistance toll-free at 888-744-6513 or visitpsob.gov.If you are a VRS member, you may beeligible for other benefits in addition tothose provided through LODA. You mustapply separately for these benefits. For moreinformation, contact your employer, visitvaretire.org or logon to your account atmyvrs.varetire.org.State BenefitsState law provides certain tax and educationbenefits to survivors of individuals killed inthe line of duty: Pursuant to § 58.1-3219.14, on or beforeJanuary 1, 2017, surviving spouses areexempt from real estate taxes on theirplaces of residence.13 LINE OF DUTY ACT PARTICIPANT GUIDE Pursuant to § 23.1-609, surviving spousesand any children between ages 16 and 25of individuals killed in the line of dutyare entitled to a waiver of undergraduatetuition and mandatory fees at any publicinstitution of higher education.

6. Applying for LODA BenefitsTo receive a LODA benefit, the claimant mustwork with the employer to file a claim withVRS using the claim form referenced at theend of this guide. The claimant will workwith VRS, the employer and others at eachstep in the process.Responsibilities Duringthe Claim ProcessClaimant Submit a completed claim form, Claim forLine of Duty Act (LODA) Benefits, to theemployer. Provide all necessary supportingdocumentation. Submit forms to VRS.VRS Conduct both preliminary and detailedreviews of the claim. Communicate with claimants throughoutthe process, including providingacknowledgments, approvals, postapproval forms and appeal information. Communicate with all employers aboutapproval/denial of claims.14 VALODA.ORG 888-827-3847 Make death benefit and health insurancepremium payments on behalf of thoseemployers that participate in the LODAFund. Notify employers that do not participatein the LODA Fund that death benefit andhealth insurance premium payments aredue. Notify DHRM about claim approval. Pay Retroactive Health InsurancePremium Reimbursement for LODA Fundparticipating employers.Tutorial: How to Apply for LODA BenefitsView this tutorial at valoda.org/claims.Employer Complete the employer section of theclaim form when requested. Submit the claim to VRS within sevendays, unless the claimant otherwiseintends to submit the claim on his or herown. If desired, provide VRS any evidencerelating to the claim within 30 days of VRSreceiving the claim. Pay the LODA benefit once VRS approvesthe claim: If the employer participates inthe LODA Fund, the fund coversdeath benefit payments, LODAHealth Benefits Plans premiums andRetroactive Health Insurance PremiumReimbursement payments. If the employer does not participate inthe LODA Fund, the employer makesdeath benefit payments to beneficiaries,makes LODA Health Benefits Planspremium payments to DHRM andmakes Retroactive Health InsurancePremium Reimbursement payments toclaimants. Provide benefits training to LODA-eligibleemployees and volunteers within 30 daysof hire and every two years thereafter.Training material, available on the LODAwebsite, is developed by VRS and DHRM,in consultation with the Secretary of PublicSafety and Homeland Security.

LODA Claims ProcessDHRMDetailed Claim StepsClaimClaimant submits claim form and supportingdocumentation to the employer.If the claimant is approved for LODAbenefits, VRS will send an approval letter tothe claimant. DHRM will review for eligibilityfor LODA Health Benefits Plans uponreceiving a completed enrollment form fromthe claimant.The employer completes a section of the formand has seven days from receipt to submit theclaim to VRS, unless the claimant otherwiseintends to submit the claim on his or her own.Within 30 days of VRS receiving a claim, theemployer may, but is not required to, submitto VRS any evidence regarding the claim.Overview of the Claims ProcessAcknowledgmentClaim ComponentsClaimants should carefully review the claiminstructions found at the back of this guide.Ensure all required information is completedon the form and required information isincluded with the claim. Insufficient ormissing information will delay the processingof the claim and may lead to the claim beingdenied.VRS sends a letter to the claimant andemployer acknowledging receipt of the claim.Preliminary ReviewVRS conducts a preliminary review,determining if the position is LODA-eligibleand if the death or disability could havehappened in the line of duty: If the claim passes this review, the15 LINE OF DUTY ACT PARTICIPANT GUIDETraining topics include the importance ofhaving a will and submitting a claim. Formore information, visit valoda.org/claims.

claimant will receive a notification letterfrom VRS and the claim will move to adetailed review. If the claim is denied, the claimant willreceive a notification letter from VRSthat provides a reason for the denial andappeal information.Detailed ReviewVRS conducts a detailed review, whichassesses whether the claim is completeand can include a Virginia State Policeinvestigation and review by the VRS MedicalBoard. VRS may send the claimant a letterrequesting additional information, if needed.Virginia State Police ReviewThe Virginia State Police assists VRS inits review by investigating LODA claimsto gather and verify information aboutthe incident and collect documentationconcerning the claim.If conducting an investigation of an incidentthat resulted in the death of a LODA-eligibleindividual, the Virginia State Police may askthe claimant to supply additional supportingdocumentation, including a death certificate,coroner’s report, will and other items, beforemaking its recommendation to VRS.Medical Board ReviewVRS uses an independent medical board toreview the medical information submittedwith LODA claims and to recommend to VRSwhether to approve or deny a claim. The VRSMedical Board is comprised of physicians andother healthcare professionals.Determination16 VALODA.ORG 888-827-3847VRS will acknowledge if the claim isapproved or denied. If the claim is approved: VRS will mailthe letter of approval to the claimant. VRSwill also send a letter to the employer.VRS will notify DHRM, the LODA HealthBenefits Plans administrator, that the claimhas been approved. DHRM will provideclaimants with an application for healthplan enrollment. If the claim is denied: VRS sends theclaimant a letter that cites the reason fordenial and appeal information. VRS willalso send a letter to the employer.Health Benefits Plans EnrollmentAn approved claimant who is eligible forhealth benefits must fill out and submit theHealth Benefits Plans enrollment applicationprovided by DHRM.PaymentIn the case of a LODA death benefit payment,VRS pays the death benefit for LODA Fundparticipating employers; or VRS notifies theLODA Fund non-participating employer toprovide the death benefit payment to thebeneficiary or beneficiaries within 15 days.VRS notifies DHRM about health planenrollment eligibility and pays DHRM thehealth benefit premium for LODA Fundparticipating employers; or VRS notifies theLODA Fund non-participating employer thatthe claim has been approved, so the employercan begin payment of the LODA HealthBenefits Plans premiums.Retroactive Health InsurancePremium Reimbursement In an approval letter, VRS will notify aclaimant of the possible Retroactive HealthInsurance Premium Reimbursement. Inthe case of a LODA non-participatingemployer, VRS explains to the claimantthat the employer is responsible forreimbursement. Retroactive paymentsare only made for premiums that are notemployer-subsidized. VRS sends the Retroactive HealthInsurance Premium Reimbursement formto eligible claimants. Claimant submits Retroactive HealthInsurance Premium Reimbursement formto VRS as soon as possible. VRS reviews form and determines ifretroactive reimbursement is due toclaimant. If due, VRS pays the premiumreimbursement on behalf of participatingemployers or notifies the non-participating

employers that retroactive payment is dueto the claimant.information, contact the employer, visitvaretire.org or logon to myvrs.varetire.org.If the Claim Is DeniedIf the claim is denied, the claimant can appealthe decision. Claims may be denied based onineligibility under LODA, VRS Medical Boardor Virginia State Police review or incompleteinformation provided in the claim. The letterthe claimant receives from VRS will providethe reason the claim was denied and appealinstructions, including the number of days theclaimant has to appeal the decision. LODAappeals are handled under the VirginiaAdministrative Process Act.Other Benefits17 LINE OF DUTY ACT PARTICIPANT GUIDEIf the claimant is a VRS member, he or shemay be eligible for other benefits. For more

7. What to Do if I Want to submit a claim?Instructions for completing the Claim for Lineof Duty Act (LODA) Benefits are provided atthe back of this guide. You also can obtain theform from valoda.org.Need assistance in completing a claim?If you need help filling out a claim for LODAbenefits, your employer’s human resourceoffice, a family member or an individualauthorized to act on your behalf, such as anagent named under a power of attorney or alegal guardian, may be able to assist you.Am denied Line of Duty benefits?18 VALODA.ORG 888-827-3847If your claim is denied, you have the option toappeal. Instructions regarding appeals will beincluded with the denial letter you receive.Have a question about my benefits?This guide describes the provisions of theLine of Duty Act for all eligible disabledpersons and eli

Federal Benefits Bureau of Justice Assistance Public Safety Officers' Benefits (PSOB) Programs 888-744-6513 psob.gov The Federal Public Safety Officers' Benefit Act provides death and education benefits to survivors of fallen law enforcement officers, firefighters and other first responders, and disability benefits to officers catastrophically