EBF simplifies student proof The CSEA Employee Benefit Fund is always looking for ways to ease the burden on our members. With this in mind, EBF recently made an important change in our student proof guidelines. Starting with student certifications for the fall 2015 semester, the EBF will no longer require a statement from the Registrar’s Office. You will still need to complete the EBF Dependent Student Certification Form, but it will no longer require completion by the school. The new form can be accessed at cseaebf.com by selecting the “Download Forms” button from the home page and downloading the EBF Dependent Student Certification Form from the list of options. If you have family coverage with the EBF, your eligible dependent may continue coverage of EBF benefits up until his/her 25th birthday if they are a full-time student. To qualify for continued coverage, your child must be a full-time student enrolled for at least 12 undergraduate or 6 graduate credit hours in an accredited college or university. The credits must be in a college degree program; that is he/ meet this requirement. Six weeks before the dependent’s 19th birthday, the EBF sends a proof of student status form to the member notifying them that coverage will end as of the 19th birthday unless student proof is submitted with instructions about how to complete the form. Once student certification has been submitted, a reminder will Member Name: CSEA EBF ID #: Student Name: Student’s DOB: Member Phone #: Member Email: she must be be pursuing a formal college degree such as an Associate’s, Bachelor’s or Master’s degree. Technical courses for short duration do not I certify that my dependent student listed below meets all of the following requirements for eligibility as a dependent student. A. Age 19-24 B. Unmarried C. Is a full-time student in an accredited college or university. Yes No Yes No Yes No D. Expected date of graduation: / / E. DEPENDENT STUDENT CERTIFICATION FORM 2015-2016 1 Lear Jet Lane, Suite 1 | Latham, New York 12110 (800) 323-2732 | WWW.CSEAEBF.COM Student Name School Name School Address School City School Phone - - Zip Code PLEASE PRINT CLEARLY I confirm that the above-named dependent is registered as a: Full-time Student Part-time Student Student is in an accredited educational institution for the: 2015 / 2016 School Year I attest that the information shown above is true and complete. I understand that failure to complete this form may result in a delay, denial or termination of coverage for the above-named dependent. I understand that CSEA Employee Benefit Fund reserves the right to ask for more information as proof of the above-named dependent’s full-time student status. I agree to advise CSEA Employee Benefit Fund promptly of any changes in my child’s dependent student status. Member’s Signature Date Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim concerning any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claims for each such violation. be sent to the member each year in July reminding him/ her to submit certification for the upcoming school year. If no certification is submitted initially, no subsequent notifications will be sent. Coverage terminates three months from the end of the month in which the student completes graduation requirements. Benefits for a dependent child who is not continuing with school may continue under COBRA for up to 36 months. Any changes to dependent eligibility status must be reported to the EBF promptly. July-August 2015 The Work Force 17
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