Frequently Asked Questions
Below are some answers to some common questions we encounter.
What are my COBRA rights with regards to Dental and Vision?
State Employees
If you become ineligible for CSEA Employee Benefit Fund coverage because of retirement, termination, layoff, leave without pay or a reduction in hours, you may have certain rights to continue Plan coverage through COBRA.
Following the termination of a member’s employment status, the member is covered for 28 days after the last day worked. Unless a terminated employee elects the COBRA option, the eligibility will be ended after this 28 day period. COBRA refers to the Consolidated Omnibus Reconciliation Act of 1986, a federal regulation that gives you the right to continue benefits for a period of 36 months in the event of a change in a member’s employment status. In the event of the death of the member, divorce, legal separation, or a child losing dependency status, a dependent could receive up to 36 months of coverage. Members who are permanently disabled receive up to 29 months of coverage. Because the member is no longer working for New York State, the benefits must be paid for by the employee on a direct pay basis, either monthly or quarterly.
Once the EBF shows a member’s termination date on our system, the member will receive a COBRA application and is provided 60 days to file it with the EBF.
Local Government Members
CSEA members employed by local governments generally have the same provisions applying to the continuation of benefits but should check with their personnel department with regard to the 28 day continuation period since many local governments have waived such provisions.
Local government members are eligible for COBRA continuation for dental and vision if such coverage was available to them during the course of their active employment.
Important Recent Federal Action Regarding COBRA
On December 21, 2009 President Obama extended the American Recovery and Reinvestment Act of 2009. The law includes an expansion of COBRA to include a temporary federal subsidy for people who lose group health plan coverage due to an involuntary termination of employment.
To be eligible, the qualified beneficiary must have lost their group health plan coverage between September 1, 2008 and February 28, 2010 due to an involuntary termination of employment (other than for gross misconduct).
The Act provides a federal subsidy equal to 65% of the COBRA premium that the qualified beneficiary would be required to pay for coverage, for a period up to 15 months.
If you have any questions, you should contact the COBRA Unit at (800) 323-2732 or (518) 782-1500.
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Please Note: There are separate provisions in your CSEA contract agreement with regard to your eligibility for health insurance. In relation to COBRA, the CSEA EBF administers only dental and vision benefits.
How do I use my EBF coverage Outside of New York State?
If you reside outside of New York State, please use the following guidelines for submitting dental or vision claims to the Fund for reimbursement.
Dental
Dental coverage does not require use of a participating dentist. When using a non-participating dentist, services will be reimbursed based upon your dental plan fee schedule. The dentist has the right to bill the difference between his/her charges and the fee schedule.
The Fund provides a list of providers outside of New York State who accept our dental plan fee schedule as payment in full for services covered in the plan. A printed list of participating providers is available by calling 1-800-323-2732 or by visiting our Provider Search Utility. When searching for dental providers on our website, choose "Dental" from the Provider Type. Choose "Out of State" from the Region pull-down menu. In the County box, choose "All Counties". When the search is performed all dental providers outside of New York State will be listed.
Completed dental claims must be submitted on a universal ADA claim form. The claim should include the patients name, address, social security number, date of service, service rendered, the ADA code for the procedure and the dentist's name, address and license number. Claims can be submitted electronically or mailed to the CSEA Employee Benefit Fund, P.O. Box 489, Latham, NY 12110-0489.
Vision
Fund vision care benefits provide you with fee scheduled reimbursement for eye care services outside of New York State when a non-participating provider is used.
Call the Fund at 1-800-323-2732 or visit our website to download a Vision Care Reimbursement Form. On the menu, click on EBF Library, All EBF Forms, Vision Care Reimbursement Form. You must have this form with you when you have vision services provided. A signed, itemized receipt from the provider must be attached to the claim form, along with the doctor's signature. Vision care reimbursement forms can be mailed to CSEA Employee Benefit Fund, P.O. Box 516, Latham, NY 12110-0516.
Should you have any questions regarding any of the above information, please contact the Fund toll free from throughout the United States at 1-800-323-2732, ext. 883.
What is the Employee Benefit Fund?
The CSEA Employee Benefit Fund is a Trust Fund managed by a Board of Trustees comprised of CSEA members and chaired by CSEA President Danny Donohue. Since its inception in 1979, the Fund's mission is to provide the best possible benefits and an Ever Better Future to our members. To facilitate this mission, the Fund's Benefit Specialists attend Membership Meetings, Information Days, Health Fairs, Conferences and Workshops to assist our membership at there place of work, while our Customer Service Department is open weekdays 7:30 a.m. to 5:00 p.m. to help with claim inquiries or questions. Our union staffed offices are located at One Lear Jet Lane, Latham, New York.
Do Our Union dues pay for our benefits?
No. Your union dues do not pay for your dental and vision benefits with the CSEA Employee Benefit Fund. These benefits are negotiated through the state contract and are no cost to the member.
Who are Local Government groups?
Counties, Towns, Villages and School Districts.
As a state employee, why can't I buy into your Miscellaneous Benefits?
These benefits, (legal, maternity, hearing aid, physician co-pay, annual physical) are negotiated through your bargaining units and are offered to Local Government Municipalities. State employee benefits are negotiated with the State.
What happens when my employment status terminates?
You are covered for 28 days after the last day you worked. Unless you elect COBRA option, your eligibility will be terminated after this 28 day period. COBRA (Consolidated Omnibus Reconciliation Act of 1986) is a federal regulation that gives you the right to continue benefits for a period of 18 months in an event of a member's retirement, termination, layoff, leave without pay or reduction in hours. You will receive 36 months in the event of divorce, legal separation or child losing dependency status. You will receive 29 months if a member is permanently disabled. Since you will no longer be working for the State to receive these benefits for free, they are on a direct pay basis either monthly or quarterly. Local Government units must check with their personnel department. Once our system shows your termination date on our system you will receive a COBRA application from us and you have 60 days to fill it out and mail it back to us.
Do you offer Retirees dental coverage?
Yes. We have a Retiree Dental program offered for retirees who were previously in a dental program with CSEA. They can continue coverage with CSEA for a monthly fee. They can continue to use a participating provider on our panel.