State Benefits
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State Vision Plan
The State Vision Plan entitles members and their eligible dependents using participating optometric providers to an eye examination and one pair of glasses (lenses & frames) or contacts. Daily soft, planned replacement and disposable wear contact lenses (non-disposable) are available and no co-pay applies. The State Plan covers single vision, bi and trifocal eye glass lenses, standard progressive, photochromic, scratch guard and prescription sunglass lenses. The State Plan offers the Premier frame line and consists of approximately 300 frames in various designer styles and colors. Members, spouses/domestic partners, and dependent children age 19 through 24 (must be a full-time student) are eligible to use the benefit every 24 months. Dependent children under age 19 are eligible every 12 months.
Members/employees whose job duties require 50% or more of their work hours on a computer display terminal (CDT) are eligible to receive a second pair of glasses if a different prescription is needed or the lenses require tinting for use on the CDT. Both the dress and CDT glasses must be provided at the same time.
Members using a non-participating provider are reimbursed based on the fee schedule appearing in the Summary Plan Descriptions provided to the member. If using a non-participating provider, reimbursement is made on one set of eyewear per person.
Dilation will be covered only when professionally indicated without any additional cost to the member.
Their is a discount program, which entitles members to buy various lenses and coatings at a discount with a fixed co-payment. A fixed co-payment means that lenses and/or coatings not covered by your plan can be purchased at a discount at all EBF vision provider offices. These items include anti-reflective coatings, UV coatings, polarized lenses, plastic photosensitive lenses, premium progressive lenses, and high index lenses.
State Dental Plan
The State Dental plan is offered for a CSEA represented bargaining unit that has negotiated with your employer for Fund coverage. There is an $2,500 a year annual maximum on dental benefits available to each member and dependent(s). Whenever an estimated cost of a recommended dental treatment exceeds $250.00, it be must submitted to the Employee Benefit Fund before work begins. A pre-authorization is not a guarantee of benefits. Payment is always subject to eligibility at the time of service.
COBRA
If you become ineligible for Fund coverage because of retirement, termination, layoff, leave without pay or reduction in hours, you may have certain rights to continue Plan coverage through COBRA.
If you die, or become divorced or legally separated, or a dependent ceases to be a dependent, your spouse and/or dependent has certain rights to continue Plan coverage through COBRA. In the event of divorce, legal separation or a child losing dependent status, you or a family member must inform the Fund of the qualifying event within 60 days of the of thelater of the event or the date on which coverage would be lost because of the event.
Prescription Drug Co-Pay Benefit
Reimburses NYSHIP prescription drug card co-pays and covered prescriptions less than the co-pay once annually up to a maximum of $100 per family* per calendar year. To obtain the maximum benefit of $100, members must wait until their co-pay expenses reach $400 before filing a claim.
For purposes of the Prescription Drug Co-pay Benefit, "Family" includes Domestic Partner.
What is the benefit?
- Employees of the NYS Canal Corporation are not eligible for the Prescription Drug Co-Pay Benefit.
- Members who are enrolled in the New York State Health Insurance Program (either the Empire Plan or Health Maintenance Organization) are entitled to reimbursement once annually for NYSHIP prescription drug co-pays only for themselves and their dependents.
- Only one claim per calendar year (January - December) is processed. To obtain the maximum benefit, wait until your co-pay expenses reach $400 before filing your claim.
- If you do not accumulate $400 before the end of the year, submit your claim after December 31 for what you did pay over $300. The deadline for submission is March 31 of the following year for the co-pays accumulated during the previous Calendar Year.
Submit your completed form with original receipts or itemized pharmacy printout clearly indicating the co-pay amount, and a photocopy of your Empire Plan or HMO insurance card. Cash register receipts, cancelled checks and credit card receipts are not acceptable. The Fund will then send the check to the member. Prescriptions must be dispensed by a licensed pharmacist.
Workplace Security
The CSEA Employee Benefit Fund Workplace Security Program provides benefits to CSEA EBF eligible and enrolled members who are the victims of an assault or hostage situation while performing their job duties.
- All public employees eligible for and enrolled in the CSEA Employee Benefit Fund are covered.
- The covered employee is insured for the trauma associated with an assault or hostage situation while performing his/her job duties.
Benefit Payable:
Level One - Assault in the 1st Degree; $10,000 for incidents involving injuries or fractures requiring a stay of 2 consecutive nights, or an incident of rape for the covered employee. There is no overnight stay required for rape.
Level Two - $2,000 for assaults other than 1st Degree or fractures requiring a stay of 2 consecutive nights in the hospital for the covered employee.
Level Three - $500 for all other incidents.
- Accidental death or dismemberment resulting from assault. A payment of $10,000 per person incident; 50 percent of sum for dismemberment of either hand or foot, or loss of sight in one eye.
- Permanent Total Disability resulting from assault. A one time payment of two times the annual base salary of the covered employee.
- Captivity while in the pursuit of his/her occupational duties. 0-8 hours - 25% of annual base salary of covered employee up to $100,000 maximum. Eight hours or more - 50% of annual base salary of covered employee up to a maximum of $100,000.
- Accidental death, dismemberment or permanent total disability during captivity while in the pursuit of his/her occupational duties. A payment of 100 percent of covered employee's annual basic salary (not exceeding $500,000); 50 percent of salary for dismemberment of either hand or foot, or sight in one eye.
- Accidental death due to occupation resulting from causes other than captivity or assault. A payment of $1,000
What is the Benefit?
Criminal assaults while in pursuit of his/her occupational duties and resulting in at least 10 consecutive workdays absent from work immediately following the incident.
How to File A Claim Under This Benefit
- The Insured has the right to name a beneficiary. The beneficiary must be someone other than the Policyholder. A Designation of Beneficiary form may be requested from Pearl Carroll & Associates, LLC.
- Submit a completed Workplace Security Claim form along with copies of the filed police report signed by the investigating officer which has been reported, in person, within 48 hours of incident, a medical statement certifying the extent of injuries and proof of immediate medical attention from the attending physician which has been sought within 24 hours of incident, and documentation from your employer indicating that you were performing your job duties at the time of injury and that the injury resulted in your being disabled from all job duties for a period of ten (10) or more consecutive work days to Pearl Carroll & Associates, LLC, as soon as possible.