Include EBF in your back-to-school plans Summer is almost over! What does this mean for members of the CSEA Employee Benefit Fund? Let’s start by taking a look at some things everyone should know about their dental and vision benefits, specifically for those who have eligible, dependent children. For many people with schoolage children, the end of summer is a time when parents bring their children for dental and vision checkups before the start of the new school year. The questions you should ask yourself before scheduling an appointment are: Does my child qualify as a dependent on my benefits? The CSEA EBF covers dependents who meet certain criteria. Dependent children include: Your unmarried children, including stepchildren who permanently reside with you and legally adopted children, under the age of 19. Your legal ward under the age of 19 who permanently resides with you pursuant to a court order awarding legal guardianship to you. Any child or ward described above, regardless of age and is incapable of self support by reason of mental or physical disability, provided he or she became so disabled prior to reaching the age of 19. Any child or ward described above under the age of 25 who is a full-time student (minimum of 12 undergraduate or six graduate credit hours) enrolled in a regionally accredited college or university working towards an associate, bachelor or masters degree. Technical courses of short duration do not qualify, even if a diploma is awarded. EBF requires that current proof of student status be provided annually. Proof is considered to be a letter or statement from the college’s Registrar’s Office with the EBF Member ID Number attached or a fully completed Student Status Form available from EBF. Student proof forms can be downloaded from the EBF website at www.cseaebf.com. Things to remember before my child goes back to school: - Get pencils, pens and notebooks - Buy new clothes - Check on my child’s CSEA EBF benefits! Have I enrolled my child under my benefits? If you have one of our plans with family coverage, it is simply done by completing and submitting an enrollment form to the EBF. Enrollment forms can be downloaded on our website. Is my child eligible to receive dental treatment? If your child has never been to a dentist before or if you’re unsure of which EBF Dental Benefit you have, please contact the Dental Unit at 1-800-323-2732 and press 2 when prompted to find out their eligibility status. If you have already seen a dentist in the past and feel comfortable using your plan, contact the dental office when you’re ready to schedule an appointment. They should have a record of your last visit and what services were performed. Is my child eligible to receive vision services? CSEA EBF’s plans are available on either a 12 or 24-month benefit basis, based upon what has been negotiated into your collective bargaining agreement. If you are unsure of what vision program you belong to or when the last time the benefit was provided, please contact our Enrollment Department at 1-800-323-2732. For any questions please call EBF at 1-800-323-2732 and follow prompts to the department you need. Attention: DaVita Dialysis Centers no longer participate with Empire Plan As of Oct. 1, 2013, DaVita will no longer be a participating provider with United Healthcare, including The Empire Plan. This means that services at their affiliated hemodialysis centers will only be considered for benefits under The Empire Plan’s Basic Medical Program, in which the enrollee pays the provider’s full fee and receives reimbursement for covered services at 80 percent of eligible expenses after meeting the annual deductible ($1,000). This could significantly increase outof pocket expenses for these services compared to using a participating provider. To continue receiving Empire Plan Participating Provider Program benefits, enrollees will need to choose another dialysis service provider that participates in The Empire Plan’s network. Enrollees affected by this change have been sent a letter from United Healthcare. The letter informs enrollees of the termination of DaVita as a participating provider and also includes alternative dialysis centers that are part of the Participating Provider Program with the Empire Plan. Enrollees with questions regarding the DaVita termination should call the Empire Plan Customer Care, toll-free, at 1-877-7NYSHIP (1-877-769-7447) and press “1” for the Medical Program. September 2013 The Work Force 17
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