Page 14 - Work Force January 2017
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                                                                                                                       NYSHIP Dependent Eligibility Audit concluded; non-verified dependents removed
 Enhancements made to local government and retiree dental plans
CSEA Employee Benefit Fund’s dental plans promote oral health through excellent features and benefits designed to keep our members’ teeth and gums healthy.
Increasingly, oral health is being linked to overall health, making
it more important than ever to offer CSEA members quality dental plans.
The CSEA Employee Benefit Fund is pleased to announce a number of enhancements to our local government and retiree dental plans. These improvements are a result of suggestions by members, dentists and dental consultants and were recently approved by
our board of
trustees in the
fall 2016. These
demonstrate our
commitment to
the health and
wellness of our
members by adding even more value to your dental plans.
Enhancements to Local Government EBF Dental plans, including Sunrise, Horizon Equinox and Dutchess
Effective Jan. 1, 2017, certain allowances will be increased for these plans. Specific increases include exams, cleanings, x-rays, fillings, crowns, implant crowns, root canal therapy, periodontal services, full and partial dentures, extractions and orthodontic procedures.
Plan participants
using non-participating
dentists will notice
fewer out-of-pocket expenses. Increased allowances also help retain participating providers and ultimately save our members
money. As always, participating dentists accept our allowances as payment in full for covered services.
Exams and cleanings have
also increased to three per calendar year outside the annual maximums. The Sunrise annual maximum will increase from $2,500 to $2,850. The Horizon annual maximum will increase from $2,850 to $3,000.
Enhancements to the EBF Retiree Dental Plan
Effective Jan. 1, 2017, members and their dependents will be eligible for three exams and three
cleanings per calendar year. Increases in the plan allowances include exams, cleanings, x-rays, fillings, crowns, implant crowns, periodontal
services and extractions.
Mailings for all the new
plan booklets went out to plan participants in December. The booklets are also available for viewing, downloading or printing from our website at
The CSEA Employee Benefit Fund has a customer service department available at 800-323- 2732 to answer any questions
you may have concerning your benefits. You may also wish to try Live Chat at
  NYSHIP’s dependent eligibility verification project (ongoing since 2015) affects all NYSHIP enrollees with family health insurance (The Empire Plan, NYSHIP HMOs and NYSHIP Opt out).
The audit helps to ensure that every participant who receives NYSHIP health benefits is entitled to those benefits.
Health Management
Systems, Inc. (HMS)
has completed the
NYSHIP Dependent
Eligibility Verification Audit (DEVA) for active New York State agency enrollees and their covered dependents.
The verification and appeals period for New York state active employees ended Dec. 6, 2016. HMS is no longer
accepting appeals to reinstate dependent coverage.
Enrollees who wish to re-enroll dependents removed as a result of the eligibility audit can speak with
their agency health benefits administrator and provide
necessary dependent proof. This will allow a
reinstatement moving forward, subject to NYSHIP late enrollment provisions. Dependents
will experience a break in coverage and may be responsible for any claims
paid during the break. Further inquiries regarding
retroactive loss of coverage as a result of the dependent eligibility audit should be directed to the state Department of Civil Service at 1-800- 833-4344.
                                                                                    Empire Plan claims deadlines for calendar year 2016
Empire Plan enrollees have until April 30, 2017, 120 days after the end of the calendar year, to submit medical expenses which were incurred during the 2016 plan year to:
United HealthCare Service Corp. P.O. Box 1600
Kingston, NY 12402-1600
For the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non-network physical therapy or chiropractic services.
Empire Blue Cross and Blue Shield NYS Service Center
P.O. Box 1407 — Church Street Station
New York, NY 10008-1407
For Empire Plan and non-network Inpatient or Outpatient hospital services.
Beacon Health Options
P.O. Box 1800
Latham, NY 12110
For non-network mental health and substance abuse services.
CVS Caremark
P.O. Box 6590
Lee’s Summit, MO 64064-6590 For prescriptions filled at non- participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card.
Enrollees can call the Empire Plan at 1-877-7NYSHIP (1-877-769-7447) with questions or to obtain claim forms. As a reminder, when using
the Empire Plan’s toll-free telephone number, please pay extra attention to the choices offered by the automated system.
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 claim form, include the original billing or receipt (if requested), and don’t forget to sign the claim form.
               14 The Work Force
January 2017

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