Frequently Asked Questions
Below are some answers to some common questions we encounter. As always, if you need more information feel free to contact us.
EBF Benefits
What is the CSEA EBF?Unified Court System Employees : Click Here
Local Government Employees : Vision Benefits and Dental Benefits
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.
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 members 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 members 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 members 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 May 31, 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.
Q: How can I continue my EBF benefits into retirement?
Important: Be sure your mailing address is up to date with the Benefit Fund. This will ensure timely delivery of your COBRA information.
Q: How long do I have to elect COBRA from my retirement date?
Q: How can I pay for my COBRA?
Q: What options do I have for COBRA coverage?
Q: How much does COBRA coverage cost?
Q: What options are available when my COBRA benefits run out?
State Employees are eligible to participate in the Fund's Retiree Dental Plan. Information on the program will be included in the COBRA notification both at the beginning and end of your COBRA participation.
Q: Do I have to join CSEA as a retiree to access the EBF's Retiree Dental Plan?
Q: Where can I find a membership application to join CSEA as a retiree?
*Some Local Government employers do pay for EBF benefits into retirement. Others allow retirees to continue their benefits by paying the former employer directly. regarding your retiree benefits.
Do I need to notify the Fund of my retirement?
How can I continue my EBF benefits into retirement?
The Fund automatically generates a COBRA mailing to you at your home address once a termination/retirement date has been received from your employer.
Important: Be sure your mailing address is up to date with the Benefit Fund. This will ensure timely delivery of your COBRA information.
Note: Some Local Government employers administer COBRA DIRECTLY TO THEIR EMPLOYEES.. Please check with your Human Resource Department.
How long do I have to elect COBRA from my retirement date?
How can I pay for my COBRA?
What options do I have for COBRA coverage?
What is the cost for COBRA?
What happens when my COBRA benefits run out?
Local Government Employees may be eligible to participate in the EBF's Retiree Dental Plan if your employer has signed a Retiree Dental Memorandum of Agreement. Please click on the Retiree Dental Page link on this website and click the link for Signed Retiree Dental Memorandums of Agreement to see if your employer has authorized your participation.
Do I have to join CSEA as a retiree to access the EBF's Retiree Dental Plan?
Where can I find a membership application to join CSEA as a retiree?
Retiree Benefits
Does the EBF offer a Retiree Dental Benefit?
Miscellaneous Benefits
What are the Miscellaneous Benefits?New York State Employees (full-time)
New York State Employees (retirees)
Maternity Benefit - $200 per child - Download Form
Hearing Aid Benefit - $150 per ear/3 years - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Physician co-pay benefit - $125 per family, per calendar year - Download Form
Maternity Benefit - $200 per child - Download Form
Hearing Aid Benefit - $150 per ear/3 years - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Town of Bellmont
City of Long Beach
Annual Physical Exam - $95 per calendar year, allowed for member and spouse - Download Form
Maternity - $200 per child - Download Form
Legal Benefit - $1,000 annual benefit - see plan brochure for guidelines - Download Form
Hearing Aid Benefit - $450 per ear/3 years - Download Form
Levittown Memorial
Legal Benefit - $1,000 annual benefit - Download Form
Ossining Public Library
Legal Benefit - $1,000 annual benefit - Download Form
Smithtown Library
Legal Benefit - $1,000 annual benefit - Download Form
Maternity Benefit - $200 per child - Download Form
Annual Physical exam - $95 per calendar year, allowed for member and spouse - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form
Annual physical exam - $95 per calendar year, allowed for member and spouse - Download Form
Maternity Benefit - $200 per child - Download Form
Physician co-pay - $120 per family, per calendar year - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form
Annual physical exam - $95 per calendar year, allowed for member and spouse - Download Form
Maternity Benefit - $200 per child - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Annual physical exam - $95 per calendar year, allowed for member and spouse - Download Form
Maternity Benefit - $200 per child - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Maternity Benefit - $200 per child - Download Form
Annual Physical exam - $95 per calendar year, allowed for member and spouse - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form
Physician co-pay - $120 per family, per calendar year - Download Form
Physician co-pay - $120 per family, per calendar year - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Maternity Benefit - $200 per child - Download Form
Annual Physical exam - $95 per calendar year, allowed for member and spouse - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form
Village of Southampton
Annual physical exam - $95 per calendar year, allowed for member and spouse - Download Form
Hearing Aid Benefit - $450 per ear/3 years - Download Form
Maternity Benefit - $200 per child - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
All hearing aid, annual physical exam, maternity and legal claims are due by December 31st of the following calendar year.