Frequently Asked Questions

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 their 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.

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.

Members whose employers have negotiated for these benefits in their contract with CSEA EBF are eligible for reimbursement.

State Employees : Click Here
Unified Court System Employees : Click Here
Local Government Employees : Vision Benefits and Dental Benefits

You must first be enrolled in the EBF to be eligible for benefits. An enrollment form must be completed by the member to activate your coverage. Once enrollment is established, you will receive a membership ID card which you will present to panel providers at time of service.

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.

In order to change your address with the EBF, please complete a Change of Address form by using this link or you can call the General Member Services Department directly at 1-800-323-2732 ext. 880 to update your information.

To order a replacement EBF ID card please complete our online Request Form by following this link or call the General Member Services Department directly at 1-800-323-2732 ext. 880 to order a replacement card. There is NO charge for a replacement card.

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 36 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.

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.

State Employees (Click Here)
Local Government Employees (Click Here)

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.

While the EBF does not provide vision coverage for retirees, CSEA does offer a vision program for retiree members. The plan utilizes the Davis/Empire network of participating providers. Benefits include an eye examination, frames and lenses every 12 months. Monthly rates for the program are $10.70 (member only) and $18.45 (member and spouse). For more information or to enroll call Pearl Carroll & Associates at 1-(888)-507-1368.

Benefits other than vision and dental, negotiated by an employer for its members.

Members whose employers have negotiated for these Miscellaneous Benefits in their contract with CSEA EBF are eligible for reimbursement.

Please click on your employer:
New York State Employees (full-time)
New York State Employees (retirees)
Unified Court System Employees (full-time)
Unified Court System Employees (part-time)
Unified Court System Employees (retired)
Albany County Social Services
Town of Bellmont
City of Long Beach
City of Rye (DPW and Clerical)
Levittown Memorial
Mamaroneck School District
Ossining Public Library
New York State Liquidation Bureau
Smithtown Library
Town of Babylon
Town of Brookhaven
Town of Harrison
Town of Huntington
Town of Ramapo - (full-time)
Town of Ramapo - (retiree)
Town of Southold
Remsen School District
Village of Southampton
Village of Wappingers Falls (Highway and Clerical)
Yonkers School District

All of our forms are on our website under DOWNLOAD FORMS. You must submit the correct form for your benefit to avoid a delay in processing your request.

The EBF no longer provides its own Dental Claim Form. Your dentist will be able to provide you with a Universal Dental Claim Form which you can use when submitting a claim.

You should receive your payment within 4-6 weeks.

All prescription and physician co-pays are due by March 31st of the following calendar year.
All hearing aid, annual physical exam, maternity and legal claims are due by December 31st of the following calendar year.