Page 17 - Work Force December_2019

EBF welcomes new local government units in 2019
For 40 years, the CSEA Employee Benefit Fund (EBF) has been providing CSEA members with dental, vision and reimbursement benefits designed to keep members healthy and save them money.
Since 1981, when local government units began to negotiate EBF benefits into their contracts, we have welcomed more than 600 new
Southern Region 3
• Village of Pelham Manor - Upgrade to Equinox Dental and Platinum 12 Vision
• Hendrick Hudson School District - Upgrade to Equinox Dental and Gold 12 Vision
• NYS Bridge Authority Casual Employees - Solstice Dental and Vision
• Edgemont School District Teacher Aides - Horizon
units. Local Government units like Harrison School District, Ossining School District, Ballston Spa School District, Putnam County and the Town of Union were among the first units to recognize the value of negotiating EBF benefits into their contracts. These units not only paved the way for hundreds more local government units over the
• City of New Rochelle - Upgrade to Equinox and added Platinum 12 Vision, Legal, Hearing, Maternity, $250 Rx & Physician Co-Payments
• New Rochelle Public Library – Gold 12 Vision
Capital Region 4
years, they left a legacy of a strong contract with great benefits for our members for years to come.
The EBF would like to welcome the newest local government units to recognize that better benefits make a better contract. The following groups are new to the EBF (in bold), added new EBF benefits or upgraded their EBF benefits in 2019.
• New York State Teachers’ Retirement System - Sunrise Dental
Central Region 5
Western Region 6
• Livingston County Water and
Sewer Authority - Solstice
Dental
• Niagara Falls School District -
Solstice Dental and Vision • Newfane School District -
Solstice Dental and Vision
• North Tonawanda School District - Added Photosensitive Lenses and UV Coating
• Dental and Platinum 12 Vision •
North Colonie School District Non-Instructional - Solstice Dental and Vision
Peru School District - Upgrade to Gold 12 Vision
• East Greenbush School District - Added Gold 12 Vision
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City of Syracuse Crossing Guards - Solstice Dental and Vision
Romulus School District - Upgrade to Gold 12
Town of Sennett - Dutchess Dental and Platinum 12 Vision Village of Homer - Dutchess Dental and Platinum 12 Vision
Know Your Rights
$10,000 Accidental Death Benefit at no cost to you – sign up today!
WORKERS’ COMPENSATION
SOCIAL SECURITY DISABILITY BENEFITS
VETERANS DISABILITY BENEFITS
PERSONAL INJURY CLAIM
PERSONAL LEGAL SERVICES PLAN
TAKING CARE OF BUSINESS
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This valuable benefit is available to you as a member in good standing at no cost to you!
Since the program began in 2014, this benefit has already helped more than 40 families recover from a sudden, tragic loss.
Go to cseany.org/10KAD
to fill out the beneficiary form.
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Be sure to complete the beneficiary form (online or download and print) so this benefit goes to who YOU designate as well as the Membership Verification/Update form to ensure we have your most current information in the event of a claim.
Return completed forms to:
CSEA Insurance Department 143 Washington Avenue Albany, NY 12210
The CSEA Legal Department oversees the Legal Services Program and CSEA has endorsed the statewide law firm of Fine, Olin & Anderman, LLP, to represent members for injury- related matters. For all matters call CSEA at 1-800-342-4146.
WE CAN HELP!
For more information on available discounts, visit cseany.org/mb.
December 2019
The Work Force 17
SECTION III – Signature & Attestation
Accidental Death (AD) Beneficiary Form Customer Number TS 05050044-G SECTION I – Insured Information
Group Policyholder Name: Civil Service Employees Association, Inc.
First Name Address – Street City
M.
Last name Non-Work Email State Zip
Date of Birth Phone Number SSN
SECTION II – Beneficiary Information
Complete the section that pertains to the type beneficiary you are designating.
PRIMARY BENEFICIARY - Your first choice to receive your life insurance proceeds in the event of your accidental death. If any primary beneficiaries predecease you, that person's share will be equally divided among any remaining primary beneficiaries.
First Name Address – Street City
M. Last name
Date of Birth
Relationship to Member
% Share
You MUST designate at least one primary beneficiary. A person may only be listed once. The sum MUST equal 100%.
First Name
M. Last name
Date of Birth
Address – Street
Phone Number
City
State
Zip SSN
Relationship to Member
% Share
MUST equal 100%.
State
Zip SSN
CONTINGENT BENEFICIARY - Your second choice to receive your life insurance proceeds if ALL of your primary beneficiary(ies) are not living at the time of your death. If any contingent beneficiaries predecease you, that person's share will be equally divided among any remaining contingent beneficiaries.
If you need more space for additional beneficiaries, living trust, or estate, visit www.cseainsurance.com/Products-Forms/Term-Life to download the full form and submit to CSEA, Inc., ATTN: Insurance Dept., 143 Washington Ave., Albany, NY 12210.g
SECTION III – Signature & Attestation
I hereby authorize the Civil Service Employees Association, Inc. (CSEA), Local 1000 AFSCME, AFL-CIO, to be my exclusive representative for collective bargaining and therefore revoke any other representative that I may have previously designated. I also hereby authorize the fiscal or payroll officer of my employer to deduct CSEA dues from my salary in the amount certified by CSEA in this and succeeding years of my employment and membership. Dues, contributions or gifts to CSEA are not tax deductible as charitable contributions. However, they may be deductible as ordinary and necessary business expenses.
I hereby revoke any previous designations, and I designate the person, people, or entity named in Section II as Beneficiary(ies). I reserve the right to change or revoke this designation at any time.
I acknowledge that my membership entitles me to this $10,000 AD policy.
Member Name (Please Print) Member Signature Date (Must be date form was completed)
Job Title
First Name Address – Street City
M.
Place of Employment/Location Last name
Non-Work Email Address Date of Birth
Phone Number
SSN
Dollar amounts, fractions and decimals will not be accepted.
Member Record Verification/Update
I hereby authorize the Civil Service Employees Association, Inc. (CSEA), Local 1000 AFSCME, AFL-CIO, to be my exclusive representative for collective bargaining and therefore revoke any other representative that I may have previously designated. I also hereby authorize the fiscal or payroll officer of my employer to deduct CSEA dues from my salary in the amount certified by CSEA in this and succeeding years of my employment and membership.
Dues, contributions or gifts to CSEA are not tax deductible as charitable contributions. However, they may be deductible as ordinary and necessary business expenses.
State
Zip
I acknowledge that I am a Member in good standing, which entitles me to this $10,000 AD policy.
Member Name (Please Print) Member Signature Date
Phone Number
The sum of the Primary & Contingent Beneficiary percentages