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Assignment of benefits for non-network MHSA services
The nine dental specialties
Beacon Health Options (Beacon) is the administrator of the Empire Plan’s Mental Health and Substance Abuse (MHSA) Program.
Until recently, the Empire Plan prohibited claim payments for non-network MHSA from being sent directly to a provider. All non-network claim
payments were paid directly to the member, and the member was required to send payment to the provider of service.
The state
Department of Civil
Service recently
reviewed and revised
this policy and will allow assignment of benefits to non- network MHSA claims processed on or after March 1, 2018. Beacon sent a letter explaining this change to enrollees who obtained services under the non-network portion of
the MHSA Program.
If you have already paid a
non-network provider for a date of service and have not submitted a claim form to Beacon yet, do not indicate an assignment of benefits on the claim form. This will result in the
provider being paid twice for the same date of service.
If this does occur, it will be your responsibility
to recoup money owed to you from the non-network provider.
By receiving MHSA Program services
from a non-network provider, your
out-of-pocket costs are much higher. If you have
any questions or would like to discuss transitioning to a network provider, please contact Beacon’s Customer Service at 1-877-7-NYSHIP (877-769-7447), Option 3 between
8 a.m. and 8 p.m. (EST).
Fund (EBF) is proud to provide T
Oral and Maxillofacial Pathology
These dentists work closely with oral surgeons to study, diagnose and treat diseases and conditions that occur in the head, face, neck, jaws and the hard and soft tissues of your mouth.
Oral and Maxillofacial Radiology
These dentists produce, view and interpret x-rays for the diagnosis and management of diseases, disorders and damage to teeth and facial bones.
Oral and Maxillofacial Surgery
Oral surgeons provide diagnosis and surgical treatment
of diseases, injuries and defects of the mouth and jaw. These dentists typically perform difficult extractions, facial reconstructions, bone
grafts and implant procedures.
Pediatric Dentistry
Specialists in this area of dentistry focus on oral health care for infants and children through adolescence. These dentists treat developing mouths, but also promote overall dental health by teaching children to take care of their teeth and gums.
Periodontics
Periodontists treat diseases of the gums and supporting structure of your teeth. Some periodontists will also place implants.
Prosthodontics
This specialty focuses on the restoration and replacement of natural teeth. Dentists provide treatment to rehabilitate oral function by using crowns, bridges, dentures or implants.
he CSEA Employee Benefit
The Empire Plan covers Shingrix vaccine for preventing shingles
The Centers for Disease Control (CDC) recently approved Shingrix as a recommended vaccine for (Shingles) herpes zoster.
Shingrix has also been recommended by the Advisory Committee on Immunization Practices (ACIP) for the prevention of herpes zoster and related complications for those age 50 and older, and is therefore required to be covered as a preventive service for this age group.
Effective April 1, 2018, the Shingrix vaccine is covered by both the Empire Plan Medical/Surgical
Program and by the Prescription Drug Program through the CVS Caremark Vaccine Network.
There will be no enrollee cost share for the Shingrix vaccine for enrollees age 50 and older when administered by an in-network provider. Any Shingrix vaccine that was administered before April 1, 2018 will be a covered service, but will have enrollee cost share applied.
Please be aware that the Shingrix vaccine requires two shots to be administered and both Shingrix shots will be covered as described above.
comprehensive and competitive dental plans to CSEA members at the state and local government level. New York State employees, Unified Court System employees and several hundred local government units (counties, cities, towns, villages, school districts) have negotiated valuable EBF dental benefits into their contracts.
Check with your employer, refer to your contract or visit cseaebf.com and use our Benefit Search Tool to find out exactly what benefits you may be eligible for.
When you go to your family dentist
for checkups and cleanings, chances are he or she is a general dentist. At some point, you may need to see a specialist.
The difference between general dentists and specialists is additional post graduate education, specific training programs and specialized clinical practicums. The American Dental Association (ADA) recognizes nine dentistry specialties.
Dental Public Health
This specialty is concerned with the dental health education of the public, research and dental care programs. Dentists in this specialty seek to educate communities, rather than singular patients, to adopt better oral health practices and prevent and control dental diseases on a community basis.
Endodontics
Dentists specializing in endodontics treat the inside of your teeth, including the roots and pulp. These dentists often perform root canals.
May 2018
The Work Force 17