Counseling Forms

Filing a Claim

Submit the below “C.O.P.S. Kids” Counseling application form. The completed form and a copy of the child’s birth certificate should be submitted to the C.O.P.S. National Office when counseling begins. If counseling has taken place and expenses have already been paid out-of-pocket, submit a copy of the child’s birth certificate, copies of the counseling bills, Explanation Of Benefits form (EOB) from your insurance carrier(s), and copies of the canceled checks to the C.O.P.S. National Office within one year of the actual counseling. Exception to this provision has been made for families that may have been denied coverage through this program in the past because of the orginal January 1, 1990, eligibility date.

 

Funding Limitations

“C.O.P.S. Kids” will fund up to $6,000 per eligible child for out-of-pocket counseling expenses. Payments will be made to either the survivor or mental health professional when proper documentation has been received in the C.O.P.S. National Office. If counseling for the parent/guardian is recommended by a health care professional in conjunction with the child’s counseling, C.O.P.S. will assume responsibility for up to $4,000 of this expense.

 

Reapplying for Additional Assistance
If a child becomes involved with extensive psychological counseling, the family may reapply by writing a letter to the C.O.P.S. National Office asking for “C.O.P.S. Kids” additional assistance. Additional financial assistance will be given consideration by the National Board on a case-by-case basis if surplus funds exist in the “C.O.P.S. Kids” account.

Any and all information submitted to Concerns of Police Survivors in conjunction with the “C.O.P.S. Kids” program will be treated as confidential, privileged information. Family surnames and names of children will never be included in any printed report that leaves the National Office.

 

Eligibility
Any dependent child of a law enforcement officer killed in the line of duty (according to federal government criteria) since May 14, 1984, is eligible. Additionally, any child recommended for counseling through the annual May “C.O.P.S. Kids” counseling sessions is eligible for this reimbursement. Eligibility for financial assistance with counseling expenses ceases with the child’s 22nd birthday.

 

Counseling Application