Chicago Police DepartmentEmployee Resource E07-04
Waiver of Chicago Fire Department Emergency Medical Service Fees
Issue Date:17 September 2004Effective Date:18 September 2004
Rescinds:A04-12
Index Category:Benefits
I.Purpose
This directive informs Department members of the procedures for requesting a waiver of Chicago Fire Department (CFD) Emergency Medical Services (EMS) fees for sworn members and their eligible dependents.
II.Procedures
  • A.Collective bargaining agreements between the City of Chicago, Department of Police, and sworn Department members offer eligible Department members and their eligible dependents an exemption from fees for emergency medical services performed by the Chicago Fire Department.
  • B.Upon receiving an invoice from the City of Chicago, Department of Revenue, related to CFD-EMS services provided to an eligible Department member or an eligible dependent, the sworn Department member requesting a waiver of CFD-EMS fees will:
    • 1.obtain a Request for Waiver of CFD-EMS Fees form from his or her unit of assignment.
    • 2.complete and sign the Request for Waiver of CFD-EMS Fees form to request, and attest to the eligibility of, a waiver of the CFD-EMS fees.
    • 3.submit the request form and a legible photocopy of the invoice to the Human Resources Division, Unit 123.
  • C.Upon receiving a request for a waiver of CFD-EMS fees, the command staff member of the Human Resources Division, will ensure:
    • 1.all Request for Waiver of CPD-EMS Fees forms received by the Human Resources Division are complete and accompanied by a legible copy of the corresponding City of Chicago, Department of Revenue, invoice.
    • 2.the information attested to on the request form is verified through the appropriate resources. (i.e., Department personnel files.)
    • 3.the Human Resources Division Only section of the Request for Waiver of CFD-EMS Fees form is completed and signed, indicating eligibility status.
    • 4.if the CFD-EMS fees are designated as eligible for waiver, a copy of the City of Chicago invoice and the corresponding approved Request for Waiver of CFD-EMS Fees form are sent, via facsimile, to the City of Chicago, Department of Revenue at (312) 747-3745.
    • 5.if the CFD-EMS fees are designated as not eligible for waiver, notification is made to the requesting Department member indicating the denial of the waiver and their responsibility for payment of the invoice.
    • 6.a file containing the Request for Waiver of CFD-EMS Fees forms and their corresponding invoice copies, is maintained consistent with the Forms Retention Schedule.
  • D.The Special Activities Section will ensure immediate notifications are made to the appropriate command staff personnel of the Chicago Fire Department in the event that an on-duty eligible Department member is fatally injured and received emergency medical services provided by the Chicago Fire Department.
Philip J. Cline
Superintendent of Police
04-034 MWK/MES[PMD]