Page 17 - Work Force May 2025

18 The Work Force May 2025
Get the most out of your EBF vision plan
CSEA Employee Benefit Fund
(EBF) experts hear a lot of great
questions about vision coverage.
To help you make the most of your
benefits, we’ve put together some
simple tips to help you save time, save
money and see clearly!
Know your coverage
Review your vision plan details,
including fixed copayments, allowances
and coverage for exams, lenses, frames
and contacts. Bring a plan booklet with
you or pull it up on your phone. Refer
to specific plan features when working
with a provider.
Find an in-network provider
Use our Provider Search tool to
locate a participating provider near
you. Confirm your chosen provider
accepts your plan before your visit.
Confirm your eligibility with the EBF
before your appointment.
Use your benefits
Routine eye exams help detect
vision changes and early signs of
health issues. Don’t let your benefits
expire. Most benefits reset each year
or every other year, so schedule your
appointments before the end of the
calendar year in which you are eligible.
All eligible children under age 19 are
allowed one full service every calendar
year.
Look for additional discounts
Additional eyeglass options are
available at a reduced cost via our
negotiated fixed copayments. These
fixed copayments are independent
of any sale/coupon/deal that your
provider may already offer. Some
Important reminders about the Empire Plan HCAP Program
The Empire Plan’s Home Care
Advocacy Program (HCAP)
provides coverage for home care
services, durable medical equipment,
and related medical supplies.
HCAP is part of the Empire Plan
Medical/Surgical Program, which is
administered by United Healthcare.
As soon as the provider
prescribes home care
services, durable
medical equipment
or medical supplies,
call HCAP toll free
at 1-877-7-NYSHIP
(1-877-769-7447).
Press or say 1 for
the Medical/Surgical
Program, then 3 for
HCAP.
An HCAP
representative can help
enrollees get covered
services quickly with paid-in-
full benefits (when using an HCAP-
approved provider). The HCAP team
will arrange or help arrange for care
with approved providers in the area,
and for ongoing care, will send a letter
of confirmation.
There are six main types of
equipment and services covered
under HCAP when they are medically
necessary:
Durable Medical Equipment and
Related Supplies covered under
HCAP is medical equipment that is
for repeated use (not a consumable
or disposable item), is used primarily
for a medical purpose, is appropriate
for use in the home and is generally
not useful to a person in the absence
of a sickness or injury. Examples of
durable medical equipment
that can be covered
under HCAP includes,
but is not limited
to, hospital beds,
manual wheelchairs
and power
mobility devices,
continuous positive
airway pressure
(CPAP) devices
and accessories,
nebulizers, and
oxygen equipment.
Medical supplies covered
under HCAP include diabetic
supplies, ostomy supplies and supplies
used with covered durable medical
equipment, such as oxygen tubing
and oxygen masks. Call HCAP prior to
receiving durable medical equipment
or supplies.
Diabetic and Ostomy Supplies
covered under HCAP include
glucometers, test strips, lancets,
ostomy baseplates and pouches.
Supplies must be prescribed by a
physician and determined to be
medically necessary. For most diabetic
supplies, call the Empire Plan Diabetic
Supplies Pharmacy at 1-800-321-0591.
Insulin pump requests must receive
HCAP authorization. For ostomy
supplies, call Byram Healthcare
Centers at 1-800-354-4054.
Skilled Nursing Services covered
under HCAP include nursing in the
home where skilled care is provided.
Care must be ordered and supervised
by a physician. HCAP does not provide
custodial care, companionship or
assistance with daily living, including
care or services provided by a home
health aide.
Home Infusion Therapy Services
covered under HCAP includes, but is
not limited to, the administration of
medications or nutritional therapies
(prescribed and supervised by a
physician) and administered in the
home by a nurse.
Communication Devices may
be covered under HCAP. The rental
or purchase of devices ordered
or prescribed by a physician can
be covered if a speech-language
pathologist determines the patient is
unable to communicate through typical
means, including speech and writing.
Enteral Formulas covered under
HCAP include nutritional replacements
taken by mouth or through a feeding
tube that provide basic nutrition
when food in its usual form is not
appropriate or adequate to meet
the individual’s nutritional needs.
HCAP covers nonprescription enteral
formulas for home use when the doctor
gives a written order that identifies
medical necessity. Prescribed enteral
formulas must be proven safe and
effective for the diagnosis.
HCAP pre-certification of covered
services save enrollees money and
there will be no claim forms to fill out.
Individuals must call HCAP and set up
network providers prior to receiving
paid-in-full benefits.
Empire Plan enrollees and
dependents requiring HCAP services
should call the Empire Plan toll free
at 1-877-7-NYSHIP (1-877-769-7447)
and press or say 1 for the Medical
Surgical Program, administered by
UnitedHealthcare, then 3 for HCAP.
HCAP representatives are available
Monday through Friday, 8 a.m. to 4:30
p.m. Eastern time. HCAP voicemail is
available 24 hours a day, seven days a
week to leave a message at any time.
In an emergency, to get the care or
equipment/supplies needed, then call
HCAP within 48 hours or as soon as
possible. Covered services and items
can be certified if HCAP determines
that the urgent or emergency services
were medically necessary.
of those sales/coupons/deals your
provider offers may not be able to be
used in coordination with a benefit, but
it never hurts to ask.
FSA or HSA funds can help
If you have a
Flexible Spending
Account (FSA) or
Health Savings
Account (HSA),
use those funds
for eligible vision
expenses beyond
what your plan
covers.
Keep it simple
Inform the provider you would like
to stay within the plan limitations.
When possible, choose frames and
lenses that are part of the collection.
Fancy lenses and coatings are not
mandatory - they are recommendations
and are optional.
This article, more great information
about your EBF benefits, opportunities
to provide feedback, and a chance
to win are all
featured in
this quarter’s
EBF Insights
Newsletter which
was emailed
to our portal
subscribers.
Not getting the
newsletter? Be
sure you have
created an EBF Member Portal account
and have an up-to-date email address.
Visit cseaebf.com and select Member
Portal to get started.