Page 18 - Work Force November 2024

Making sense of your dental coverage
Navigating dental benefits can sometimes feel overwhelming but understanding a few key documents like the Explanation of Benefits (EOB) and pre-determination can make the process easier.
In this article, we will break down what these terms mean, how they affect your dental care and how you
can access them
through the CSEA Employee Benefit
Fund (EBF) Member Portal.
What is an EOB?
An Explanation of Benefits (EOB) is a document provided by the EBF after you receive dental services.
It outlines the services performed, what your dental plan covered, what
portion you are responsible for,
and any procedures that were not covered. Please note that an EOB
is not a bill, but a summary to help you understand how your EBF dental benefits were applied to the claim.
What is a pre-determination?
A pre-determination is a process where your dentist submits
a treatment plan to the EBF for review before performing
the procedure. The EBF then provides an estimate of
what will be covered and what you may need to pay out of pocket. This ensures you are informed of your financial responsibility and whether the treatment is covered by your plan before proceeding.
How to acccess documents?
Members with an EBF dental plan can access their dental EOBs and pre-determinations through the Member Portal.
Simply visit cseaebf.com, click on the Member Portal icon, and log in or sign up if you have not done so already. If you have forgotten
($640). The carryover will be transferred for use any time during the 2025 year. Monies carried over are not included in the maximum contribution limit.
Dependent Care Advantage Account (DCAA) – Up to $5,000
per year, per household, can be contributed in the DCAA through pre-tax payroll deductions for elder care, disabled dependent care or child care expenses.
• After eligible services have been received, the employee submits for reimbursement.
• The DCAA employer contribution will continue to be available in 2025.
• The 2025 DCAA will include
a grace period. The grace period allows an additional 2.5 months to incur dependent care expenses. Any remaining 2024 funds can be used to pay
your EBF ID, you can retrieve it by selecting “Lookup Your EBF ID” and using your Social Security number.
Once logged in, select the “Get EOBs” tab, choose the patient, and then select the date of service for the EOB or pre-determination you wish to view.
for expenses incurred between Jan. 1, 2025, and March 15, 2025.
Adoption Advantage Account (AAA) – Eligible employees may contribute up to $16,810 (subject to adjustment by federal government) in the AAA for 2025 plan year. Contributions are made through pre-tax payroll deductions and may be used for expenses related to the adoption of an eligible child.
Additional information regarding the state’s FSA programs can be obtained by calling the FSA hotline at 1-800-358-7202 or visiting https://oer.ny.gov/fsa.
Flex Spending Account update
The Flex Spending Account (FSA) is a negotiated state employee benefit that helps you save money by allowing you to pay certain expenses with pre-tax dollars. The Health Care Spending Account, the Dependent Care Advantage Account and the Adoption Advantage Account are benefit programs available under New York State’s FSA.
dollars into your FSA account and then do not have enough eligible expenses during the plan year to equal the amount you contributed, you may lose funds.
Important information about the Flex Spending Accounts:
Health Care Spending Account (HCSA) – Contributions to the HCSA are made through pre-tax payroll deductions and may be used for eligible health care expenses that are not covered by a health plan.
The state’s FSA Open Enrollment Campaign for the 2025 plan year
will begin November 1 and end on
Dec. 9, 2024. Total Administrative
Services Corporation (TASC) is the administrator of the state’s FSA
programs. TASC handles enrollments
for the 2025 plan year and processes
the run-out claims for the 2024 plan
year. •
Because of the tax advantages of the FSA, the Internal Revenue Service (IRS) has strict guidelines for its use. One of these guidelines is commonly known as the “use it or lose it” rule. Put simply, if you contribute pre-tax
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18 The Work Force
November 2024
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The maximum annual contribution to the HCSA
is $3,200 – this maximum
is subject to update by the federal government. Employees will continue to access a debit card for use
for eligible purchases and charges.
The 2025 HCSA will include the maximum carryover of 2024 remaining balances allowed