Page 18 - Work Force April 2024

Using EBF benefits out of state? Five things you should know
If you have CSEA Employee Benefit Fund dental and vision benefits and plan to be out of the state, here are important things to know about using the benefits.
1. Check our provider lists. The best way to get the most value out of your dental and vision benefits is to use a participating provider. With more than 4,000 dental offices and 15,000 vision providers in our network,
you may be able to find a participating provider even if you are out of state. Use our Provider Search tool at our website at cseaebf.com for the most up-to-date lists.
2. Know who your insurance provider is and have your EBF ID ready.
The CSEA Employee Benefit
Fund (EBF) provides dental and/ or vision benefits to New York State CSEA members, as well
as members employed by more than 600 local government and public authorities. Once you have enrolled, you will receive an EBF Benefit ID card. You will need to provide your EBF ID number when making an appointment. You can access your member number, view, and print an ID card from the EBF Member Portal. Access the portal by
selecting the link on our website.
3. Our vision network is nationwide.
There are now EBF vision provider locations in all 50 states, as well as the District of Columbia and Puerto Rico. EBF members and their dependents can visit a plan provider whenever they are eligible for vision care services, wherever they are, throughout the U.S. The provider must contact Davis Vision to get authorization.
4. If you cannot find a participating dentist, you can still have the work completed, especially if it is an emergency. Our dental plans are structured in a way that allows for substantial savings even at a non-participating dentist. Be sure to inform the dental office you do have dental insurance. The dental office will complete a standard ADA claim and submit it to the EBF for processing. EBF claim forms can be downloaded and printed from our website. Some dental offices may want to submit the claim electronically.
If the office has questions about submitting your claim, have them call us or visit the dental provider portal on our website. If the dental office is unable to submit a claim directly
to EBF, you will need to submit the claim form along with a statement of services rendered.
If you need assistance completing the form, call EBF at (800) 323-2732 and ask to speak to a dental representative.
If you permanently reside
out of state, you have the
option of submitting claims and supporting materials through our Member Portal.
5. Once the work is completed at an out-of-state non-participating dentist, expect to be charged
upfront for all dental services.
Once your claim is submitted,
an EBF dental representative
will process the claim and reimburse the eligible patient up to your dental plan’s schedule
of allowances. Plan summaries, each complete with a schedule of allowances, can be found in your Member Portal.
To learn more about which dental and vision programs might be available to you, use our Benefit Search tool at cseaebf.com.
Deadline approaching for 2023 Empire Plan claims
Empire Plan enrollees have until April 29, 2024 (120 days after the end of the calendar year) to submit medical expenses incurred during the 2023 plan year.
Network providers/pharmacies will submit claims directly to the appropriate insurance carrier on your behalf when provided with all necessary information.
If you have a non-network claim submission, make sure you complete the requested subscriber information on the appropriate claim form, include the original billing or receipt (if requested), sign and return the claim form.
Claim submission for Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non-network physical therapy or chiropractic services:
United Healthcare
P.O. Box 1600
Kingston, NY 12402-1600
Claims submission fax (845) 336-7716 Claim form: https://www.cs.ny.gov/ forms/UHC_3875.pdf
Claim submission for Empire Plan non-network inpatient or outpatient hospital services:
Anthem Blue Cross - NYS Service Center
P.O. Box 1407 - Church Street Station New York, NY 10008-1407
Claims submission fax: (866) 829- 2395
Claim form: https://www.empireblue. com/nys/resources-forms
Claim submission for Empire Plan non-network mental health and substance use services:
Carelon Behavioral Health
P.O. Box 1850
Hicksville, NY 11802
Claims submission fax: (855) 378- 8309
Claim form: https://www.cs.ny.gov/ forms/cms1500-MHSU.pdf
Claim submission for Empire Plan prescriptions filled at non- participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card use: CVS/Caremark
P.O. Box 52136
Phoenix, AZ 85072-2136
Claim form: https://www.cs.ny. gov/forms/CVSCM_Claim-Form_ commercial.pdf
Call the Empire Plan directly at 1-877-7-NYSHIP (1-877-769-7447) with any questions about claims submission.
18 The Work Force
April 2024