Page 17 - Work Force April 2026

What does it mean when a
dentist ‘takes’ your insurance?
When scheduling a dental
can charge their normal fee. The
appointment, many CSEA
plan will still pay up to the allowance
members ask the same question: “Do
amount, but if the dentist charges
you take the plan?”
more than that amount, the member
It sounds simple, but the answer
is responsible for the difference.
can mean different things.
Another situation members
Under CSEA Employee Benefit Fund
occasionally run into involves
(EBF) dental plans, members are free
specialists working within a dental
to visit any licensed dentist. Dentists
office. The general dentist may
may participate with the plan in
participate with the plan, but a
different ways, which
specialist—such
can affect what you
as an oral surgeon
pay.
or endodontist—
Some dentists
may not. If the
are contracted
specialist does
participating
not participate,
providers with the
they may charge
EBF. These dentists
more than the plan
have agreed to accept
allowance and bill
the plan’s allowance for covered
the member for the balance.
services as payment in full. In other
The EBF does not recommend
words, they follow the plan’s fee
any particular dentist. But knowing
schedule and will not bill members
the difference between contracted
more than the allowed amount for
participating providers and dentists
covered services.
who simply “take” the plan can help
For members, that usually means
members avoid unexpected costs.
predictable costs and fewer surprises.
Members can search for EBF’s
Other dentists may say they “take”
contracted participating providers or
the insurance but are not contracted
learn more about their dental benefits
providers. In these cases, the dentist
by visiting cseaebf.com.
Before your appointment: Three quick questions
•
Do you participate with the
Some specialists may not
CSEA EBF dental plan?
participate in the plan.
Contracted participating
•
Should I request a
providers accept the plan
pre-authorization?
allowance as full payment for
For larger procedures, this
covered services.
can help estimate coverage
•
Will any specialists be
before treatment begins.
involved in my treatment?
Keep your NYSHIP health
insurance file up-to-date
If you meet the qualifications and
NYSHIP coverage. Civil Service
carry NYSHIP health insurance,
sends reminders to NYSHIP enrollees
whether under The Empire Plan
reinforcing the importance of
or a NYSHIP HMO, the “General
enrollees to keep their NYSHIP
Information Book for NY Active
enrollment record up to date, to
Employees” includes important
provide timely notification of address
information regarding NYSHIP
changes and advise if a dependent
eligibility, enrollment options, how
no longer meets NYSHIP eligibility
changes to employment impact health
requirements.
insurance and enrollee’s associated
Examples of health insurance
cost contributions.
updates that an enrollee should
A copy of the General
contact their agency HBA or
Information Book is mailed
t

S
NYS Business Services
to all enrollees and can
n
t
a
e
t
Center:
also be found on the
m
e
•
Change in your
Department of Civil
n
r

name, mailing
Service’s NYSHIP
e
address, home
online website. It
v
P
address, or
is recommended
Protecting Your Benefits
o
that you keep the
G
Promoting Good Health
l
a
HEALTH BENEFITS
DEPARTMENT
health insurance
L

o c
r
phone number
i
•
Changes that
v
General Information
a
result in your
Book with important
t
health insurance
e
coverage type
materials for reference.
e
S
(individual/family)
c
The agency health
r
o
t
•
Seeking to add or delete
benefits administrator (HBA) or
an eligible dependent
the New York State Business Services
•
A covered dependent loses
Center performs various tasks to
eligibility
assist NYSHIP enrollees. The HBA
•
You get divorced (a copy of
serves as the employee’s contact for
the divorce decree must be
health insurance information and
submitted)
updates. The HBA communicates
•
Employment status changes and/
enrollee health insurance enrollments
or removal from the payroll
and updates to the NYS Department
•
You are planning to retire or leave
of Civil Service so enrollment files are
state service
updated timely.
To avoid delays, please ensure
Please note that it is the enrollee’s
changes are made in a timely manner.
responsibility to notify the agency
Questions about specific health
HBA/Business Services Center of
insurance plan benefits should be
any changes that may affect your
addressed directly with your plan.
Empire Plan Enrollees: Anthem Blue Cross and Mount Sinai Health System update
Mount Sinai Health System is no
services at in-network benefit level
•
Any previously preauthorized
services covered under the Empire
longer participating in Anthem’s
through delivery and post-partum
services
Plan’s Medical/Surgical Program
network effective March 4, 2026.
care. In addition, the following
To inquire if a treatment qualifies
administered by United Healthcare
Mount Sinai Health System consists
services from Mount Sinai Health
under Continuity of Care, Empire
(UHC). Medical/Surgical services as
of Mount Sinai Brooklyn, Mount Sinai
System will also be considered
Plan enrollees should call the NYSHIP
covered under UHC will continue to
Hospital, Mount Sinai Morningside,
in-network:
toll-free line at 1-877-7-NYSHIP
be in-network at Mount Sinai.
Mount Sinai Queens, Mount Sinai
South Nassau, Mount Sinai West, and
•
•
Emergency cases
(1-877-769-7447) and press or say
For the most current information
If an in-network hospital to
2 for Anthem. Representatives are
regarding the Mount Sinai contract
the New York Eye and Ear Infirmary
provide required services is not
available Monday-Friday, 8:00 a.m. to
negotiations, visit athembluecross.
of Mount Sinai.
available within a 30-mile radius
5:00 p.m. ET.
com/nys for more details and
Pregnant individuals may continue
or a 30-minute travel time from
Please note that current
updates about these discussions.
your home
negotiations do not impact any
18 The Work Force April 2026