Page 17 - Work_Force_June_2018

Negotiations unsuccessful
between hospital, insurer
In-network services available through June 30, 2018
Important dental plan enhancements
There is value in your union membership. At the CSEA Employee Benefit Fund (EBF), we continually strive to improve our benefits to meet your needs and improve your quality of life.
If your CSEA contract includes one of the EBF’s competitive dental, vision or reimbursement benefits, be ensured you have a team of dedicated people working on creative ways to
improve your health and well-being and save you money.
In 2015, the EBF
Board of Trustees
approved an
upgrade to many of
our dental plans that included an implant benefit. Our dental plans were among the first in the nation to offer such coverage. Since then, EBF has provided millions of dollars in assistance to CSEA members and their families.
As the success rate for implants has increased over the years, this procedure has become a much more common standard of care. The EBF saw this as an opportunity to help our members even more.
CSEA President and EBF
Chairman Danny Donohue and the EBF Board of Trustees are pleased to report that effective July 1, 2018, those EBF dental plans with an implant benefit will see allowances raised from the current $750 per implant (up to twice annually) to $1,000 per implant.
Our Board of Trustees also voted to approve allowances for implant abutments providing even
more coverage
for this service. These allowances are outside of the member’s annual plan maximum and are in addition to the crown coverage
already offered by the plan. The board also approved a new benefit for various bone graft procedures for all EBF dental plans.
These upgrades are worth thousands of dollars to EBF members who need these specialized procedures. Offering valuable benefits, excellent service and quality care to our members is our priority. Please visit our website at cseaebf.com for more information on the EBF, our plans and these enhancements.
Value
Generous annual maximums. Services outside annual max.
Service
EBF is set up to meet member needs rather than maximize profits.
Quality
Plans grow and change based on the needs of CSEA members.
Providers
Our providers accept our payment in full for all covered services.
Your Union. Your Benefits. The CSEA Employee Benefit Fund.
Empire Blue Cross/Blue Shield, administrator of the Empire Plan Hospital Program, regularly re-negotiates its hospital contracts with participating hospitals.
CSEA has been notified that negotiations for a new multi-year agreement between Empire Blue Cross/Blue Shield and South Nassau Communities Hospital (“South Nassau”) (formerly part of
the Long Island Health Network) have been unsuccessful to date.
Thus, South Nassau Communities Hospital
has terminated from
Empire’s network
effective May 1, 2018.
Per New York law, this termination is subject
to a “cooling-off’ period
through June 30, 2018. This means that both Empire and the hospital will abide by the terms of their agreement until this period ends.
If no agreement is reached before the end of the cooling-off period, South Nassau will be considered an out-of-network hospital for dates of service on or after July 1, 2018.
Presently, all acute care hospitals within New York State have a contract with Empire Blue Cross/ Blue Shield. We are aware that not all
hospital negotiations are successful and have experienced hospitals becoming non-network from the Empire Blue Cross/Blue Shield networks for a few weeks to several months’ time.
Please note this possible termination affects all Empire Blue Cross/Blue Shield plans, not just the Empire Plan (includes
HMOs, PPOs, indemnity, etc.). Letters describing
the problematic negotiations have been
sent to Empire Blue Cross/Blue Shield enrollees. The letter describes limited
services which will be covered on an
in-network basis. Other claims will be handled as non-network after 12:01 a.m.
July 1, 2018.
Enrollees who are currently
receiving services or are scheduled to receive services from South Nassau should call Empire Blue Cross/Blue Shield toll-free at 1-800- 495-9323, Monday through Friday, between 7 a.m. and 8 p.m.
Customer service representatives will be happy to answer any questions you may have and help you select an alternative hospital that is participating, if necessary.
Retiring soon?
Join a Retiree local!
• represenetation
• • •
member-only benefits member subscriptions local meetings
To learn more, visit cseany.org/retiree-members or on Facebook: facebook.com/cseanyretirees
June 2018
The Work Force 17