Dental And Vision Care
The CSEA Employee Benefit Fund provides vision and dental benefits at no cost to employees who meet the eligibility requirements for participation in the New York State Health Insurance Program. These benefits are available to you and your eligible dependents whether you enroll for individual or family coverage in the health insurance program or decline to participate. Coverage under the CSEA Employee Benefit Fund is not automatic you must first enroll yourself and your dependents.
Detailed information about eligibility requirements for you and your dependents, covered benefits, and instructions on how to use your plans may be found at the CSEA Employee Benefit Fund.
Eligible members and dependents are entitled to one comprehensive dental examination and cleaning every 6 months. Other services may be covered in full if performed by a participating provider. If you choose to use a non-participating provider, you will be eligible for a partial reimbursement. Dependent children who are age 19 or older, but under age 25, are eligible if they are full-time students. Student verification will be required.
How do I enroll?You will be eligible for coverage as soon as you complete a 28-day waiting period. To enroll, complete the CSEA Enrollment Card provided by the CSEA Employee Benefit Fund or enroll online.
Dental And Vision Programs Rules In Common
- Not All participants have access to both Programs
- You have a maximum of 90 days from your termination date due to retirement or 90 days from your COBRA end date due to retirement to elect the Program.
- You had to have a negotiated EBF dental or vision plan on the date of your retirement to access the program.
- Your employer had to sign a separate Retiree Memorandum of Agreement for either/both program during the course of your employment to be eligible for participation.
- Participants with access to both programs and elect both programs must start both programs in the same month.
- If you are eligible and elect a Retiree Program, monthly premiums must be paid through the Recurring Payment Program.
- Coverage is offered in three tiers: Retiree Retiree +1 and Family.
- A minimum of 12 months participation is required for the enrollee and any eligible dependents.
What Services Are Covered By Csea Dental Insurance
Most necessary dental care receives complete coverage from the CSEA plan. Preventive and restorative dentistry, orthodontics, and dental sedation all receive complete coverage when you visit a CSEA dentist. CSE plans even offer coverage for services not covered by traditional benefit plans including dental implant placement and restoration. You can also choose to visit an out of network dentist or specialist, but you will be responsible for any differences in the fees charged by this practice and the treatment costs as outlined by your CSEA plan. Each plan has a specific annual coverage maximum, so its important to keep track of your treatments to ensure you do not exceed this annual plan maximum.
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Icipating Providers And The Csea Employee Benefit Fund
The CSEA Employee Benefit Fund provides dental and vision benefits to CSEA represented governmental employees throughout New York State.
The EBF strives to provide quality benefits to our members at the most affordable price. Participating providers are integral to our program and our true partners in providing this care.
We would like to invite you to become an EBF participating provider. Joining our panel of providers creates the opportunity for you to expand your practice by providing access to more than 260,000 covered CSEA members and their dependents.
Summary Of Benefits For Retired Seiu And Csea Members
Life Insurance: Retirees must meet eligibility requirements to continue University-paid group life insurance after retirement. Retirees must have reached at least age 62 years, completed at least ten years of service and were covered on the Plan the day prior to retiring. The value of the life insurance benefit is as follows:
- Age 62- 64 1.00 x annual base salary on the day immediately preceding retirement
- Age 65- 69 .67 x annual base salary on the day immediately preceding retirement
- Age 70 + $5000.00
Health & Dental Insurance : During the life of the union contract agreement between CSEA and SLU, employees who retire between ages 62 and 65, and have completed ten years of full-time service, shall be permitted to continue coverage on the comprehensive group health plan and prescription drug card program until becoming eligible for Medicare. The University will pay an amount equal to 50% of the cost of individual coverage during this period the employee shall pay any remaining premiums. Dental insurance is available through COBRA for 18 months after retirement. Please see Human Resources for COBRA rates.
Note: Both CSEA and SEIU have the option of paying for retiree health insurance coverage through the use of unused accrued sick leave. Please refer to your union bargaining unit agreement or contact the Human Resources Office for specific details.
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Benefits Of Visiting A Csea Dentist
There are many benefits to picking a CSEA dentist, including:
- Your dental insurance provider understands the CSEA insurance plan, its coverage, treatment limits, and annual maximums and can maximize your benefits
- You dont need to worry about paying additional fees to cover the difference in cost between the CSEA insurance plan pricing and the dentists charged fees
- CSEA dentists are happy to work as your advocates if you need specialty care from providers who may not be in the CSEA network to ensure you receive the maximum coverage
- You dont need to worry about exceeding your annual plan maximums as the dentist and team will help you plan your treatments accordingly
Dental & Vision Benefits For Csea Retirees
As a CSEA member, your dental and vision coverage will end 28 days after the last day of the payroll period in which you worked. You have the following five options for continuing dental and vision coverage:
Option 1: The Consolidated Omnibus Budget Reconciliation Act
About: COBRA is a federal law that requires most employers sponsoring group health plans to offer employee and their families the opportunity for a temporary extension of all types of health insurance coverage.
For NYS Retirees: If you choose to enroll you will receive both dental and vision benefits. Because COBRA is an actual continuation of benefits, coverage remains the same as it was when you were an active employee. You may keep this coverage for up to 36 months.
How to Enroll: Questions regarding COBRA coverage should be directed to the CSEA Benefit Fund at 1-800-323-2732 or 518-782-1500. Please note that coordination of benefits is NOT permitted under COBRA.
Option 2: Emblem Health Direct Payment Plan
All New York State employees who are enrolled in health insurance are automatically sent enrollment information on GHI Retiree Dental Plan at the time of your retirement.
You must enroll no later than 90 days post-retirement, or immediately following the end of COBRA coverage. You will receive an enrollment form and summary of benefits after you retire, or at the end of the COBRA Period. This plan is a conversion policy that is administered by Emblem Health .
Other Options for Dental and Vision Programs
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Empire Plan General Number: 769
The Empire Plan is a comprehensive health insurance program for New York’s public employees and their families. The plan has four main parts:
1. Hospital Benefits Programinsured and administered by Empire BlueCross BlueShieldProvides coverage for inpatient and outpatient services provided by a hospital, skilled nursing facility care and hospice care. Includes the Centers of Excellence for Transplants Program. Also provides inpatient Benefits Management Program services, including pre-admission certification of hospital admissions and admission or transfer to a skilled nursing facility discharge planning, inpatient Medical Case Management and the High Risk Pregnancy Program.Services provided by Empire HealthChoice Assurance, Inc., a licensee of the BlueCross and BlueShield Association, an association of independent BlueCross and BlueShield plans.
Empire Blue Cross & Blue Shield Hospital & related servicesGROUP# YLSNew York State Service Center 769-7447 – check on your claims, policies etc.PO Box 1407 Church Street StationNew York, NY 10008-1407
Must call before scheduled admissions within 48 hours of an emergency / urgent hospital admission
NEW: As of 2009 OptumHealth Behavioral Solutions
Please note that you MUST ALSO CALL FOR THE FOLLOWING:
- Pre-admission certification to the hospital required for ALL TESTS such as Magnetic Resonance Imaging or CAT SCAN review
- Home Care Advocacy Program
What Does It Mean To Be A Csea Dentist
CSEA insurance benefits provide New York state, local government, and united court system employees as well as their retirees with benefit plans that cover their medical and dental care needs. As a CSEA dentist, we are happy to help you maximize your insurance for these plans. We also have an agreement with CSEA to charge the preset average and fair pricing for dental treatments. This ensures you always receive the maximum coverage when you visit our team for your dental care. Unlike other benefit plans that only give patients a percentage of the cost of necessary treatments, CSEA plans offer complete coverage for preventive and restorative dentistry services, orthodontics, and dental sedation from in-network dentists. We are proud to accept these benefits and ensure you will not need to worry about additional out of pockets costs for treatment.
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Dental & Vision Benefits
If you’re eligible, you have 60 calendar days from your appointment date to request enrollment in dental and/or vision coverage. To learn about other opportunities to enroll at a later date, including when you experience a qualifying life event, visit Eligibility & Enrollment.
Retirees should visit Retiree Plans & Rates for dental and vision coverage information.
No Cost Medicare Health Plan Counseling
Do you need help navigating the Medicare maze for yourself or a family member? Medicare can be tough to take on alone. Get your questions answered and make sure you dont overpay. Call our friendly benefit provider, United Insurance Partners and speak to Deborah Hoffman, for no-cost expert advice exclusive to CSEA members at 707-2360.
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Your Csea Dental Insurance Provider In Massapequa Park
At South Shore Dental Care, we are dedicated to helping all of our patients receive their maximum insurance benefits. Our knowledgeable team members work with insurance providers on a regular basis, so we know the ins and outs of these complex benefit plans. In addition to traditional PPO dental insurance plans, we regularly work with Local Union #3 insurance plans and CSEA benefits for state and local employees. If youre a member of a CSEA dental insurance plan, we would be happy to help you by processing and filing insurance claims, submitting predetermination requests, or simply answering your dental insurance questions. To find out more or schedule an appointment, please dont hesitate to give us a . Our friendly team will do our best to help you over the phone or schedule a consultation visit in our Massapequa Park dental office.