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 through LiveChat or our Customer Service at 800-323-2732.
The CSEA Employee Benefit Fund (EBF) has been providing quality benefits at an affordable price since 1979. The EBF is a not-for-profit labor trust that offers dental and vision coverage as well as a select offering of reimbursement benefits to the CSEA membership and their families. The benefits are collectively bargained, and because of our structure, the benefits are priced as competitively as possible while still being able to maintain a strong network of providers.
To facilitate this mission, the EBF's Marketing Representatives are made available to attend Membership Meetings, Information Days, Health Fairs, Conferences and Workshops to assist our membership at their place of work.
Our Customer Service is available 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 and can be reached at 800-323-2732.
No. CSEA and the EBF are separate organizations. Your union dues do not pay for EBF benefits. EBF benefits are negotiated on your behalf with your employer and provided pursuant to your CSEA Collective Bargaining Agreement (contract).
CSEA Members whose employers have negotiated for EBF benefits as provided by your Collective Bargaining Agreement (contract).
After your employer informs the EBF that you are eligible for EBF benefits, a "Welcome Aboard" package is sent to you automatically with an enrollment form which must be fully completed and returned to the EBF. Eligible employees may also use the "Enroll Online
" button on the home page to complete the form.
After the form is processed an EBF Member ID Card is sent with your EBF ID Number. This number is different than your CSEA ID Number. When you have the EBF ID number you can call and schedule an appointment with a participating provider. Participating providers can be located using the "Provider Search
" button on the home page.
Participating providers agree to accept EBF payments as full payment for most covered services. Non-participating providers can balance bill for any differences between what the plan pays for covered services and the provider's normal office charge.
The best way to determine the amount of benefits you have used is to save, review and tally your Explanation of Benefits (EOB) statements. Each time a claim is processed for you, the EBF sends you a statement that shows what services were submitted by the provider and the amount of benefit that was paid on those services. If you are having extensive work done, or are being treated by more than one provider, it is important to know what treatment you have had done that has not yet been processed and reflected in the EOB. You may also call an EBF Customer Service Representative at 800-323-2732 and request the amount of benefits that have been paid out to date.
Please remember that the information provided by the EBF will only reflect information available in our claims system as of the time of your call. Our records would not take into account work that has been done that has not yet been submitted to the EBF for processing. It is the member's responsibility to be aware of the treatment that has been provided. If the treatment that you require totals an amount that is over your annual maximum, you are responsible for paying the difference to your provider.
The CSEA EBF accepts the American Dental Association (ADA) claim form and other generic claim forms. A claim form should be available at your provider's office. Receipts are not accepted. Providers should be advised that the EBF also accepts electronic claims from Change Healthcare, Tesia, and DentalXChange clearinghouse. Our payor number is CX054. In addition, CSEA EBF dental claim forms are also available for download from the "Download Forms" section of our website or by clicking here: CSEA EBF Dental Claim Form
If you reside outside of New York State, please use the following guidelines for submitting claims to the EBF for reimbursement.
You can search for participating providers on our website by selecting the Provider Search
tool on the home page. Then choose "Dental" or "Vision" and select a State from the "State" pull-down menu. When the search is performed all providers from within the State you selected will be listed.If you reside outside of New York State, please use the following guidelines for submitting claims to the EBF for reimbursement.
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. Non-participating dentists can balance bill for any differences between what the plan pays for covered services and the provider's normal office charge. The EBF provides a list of providers outside of New York State who accept our dental plan fee schedule as payment in full for most services covered in the plan.
The EBF accepts the American Dental Association (ADA) claim form and other generic claim forms. A claim form should be available at your provider's office. Receipts are not accepted. Providers should be advised that the EBF also accepts electronic claims from Change Healthcare, Tesia, and DentalXChange clearinghouse. Our payor number is CX054. In addition, EBF dental claim forms are also available for download from the "Download Forms" section of our website or by clicking here: CSEA EBF Dental Claim Form
The EBF has many participating vision providers with locations in all fifty states, as well as in the District of Columbia and Puerto Rico. For member's who retire and have the option available to continue benefits under the EBF Retiree Vision Plan or COBRA, this means that your plan can be used in areas where the retiree has relocated. In addition, eligible dependent students will now be able to have their regular eligible service in the area where they are attending school instead of needing to make sure they obtain their service while home on break or summer vacation. To save on out-of-pocket costs, it is recommended to use a participating provider when eligible for annual or bi-annual services under the plan.
To change your address with the EBF, please complete our online Change of Address Form
or call the Member Services Department at 800-323-2732 to update your information.
Address changes for your CSEA Union Membership can be made by contacting CSEA Headquarters at 800-342-4146 or www.cseany.org
To order a replacement EBF ID card please use the Lookup Your EBF ID Number
tool on the home page. Enter the required information and you can print your card right from the screen. You can also select "Mail me the ID Card" to have a card mailed to you but it will take at least one week to arrive.
State EBF Members: You are covered for 28 days from the last day you worked. You may have certain rights to continue your coverage under COBRA. Unless you elect COBRA, dental and vision benefits terminate after 28 days. New York State notifies the EBF of your benefits termination date electronically.
Local Government EBF Members:Local Government employees must check with their Personnel Department to determine when benefits will end. You may have certain rights to continue your coverage under COBRA. Unless you elect COBRA, your benefits will end on the date submitted to the EBF by your employer.
COBRA (Consolidated Omnibus Budget Reconciliation Act)
COBRA is a Federal provision that gives certain rights to employees to continue benefits at your expense for a maximum of 36 months in the event of a qualifying event: Termination of employment for any reason other than gross misconduct, layoff, Leave without pay or a reduction in hours. COBRA is offered in the event of divorce, legal separation or a child losing dependent status.
By Federal Law, participants have a maximum of 60 days from the benefits termination date to complete and return the COBRA election form to the EBF.
The EBF bills for COBRA benefits on a monthly basis. Payment is made directly to EBF.
Local Government Employees
If the EBF administers COBRA coverage for your employer, a COBRA election mailing will be sent upon receipt of your benefits termination date.
The Marriage Equality Bill was effective July 24, 2011. If you were married in a jurisdiction that allows same sex marriage on or after the bill’s effective date, your spouse is an eligible dependent under EBF guidelines. To enroll your spouse, download and complete the EBF Enrollment Form
and return to the EBF. Please include a copy of your marriage certificate.
The EBF strives to provide quality benefits to eligible EBF members and their dependents. If the EBF determines that an EBF member, or a dependent of an EBF member, receives a benefit for which he/she is not eligible, the EBF contacts the member and requests that the member reimburse the EBF for the amount of the improper benefit. If the member fails to provide the requested reimbursement, the EBF reserves the right to offset that amount which the member fails to reimburse against any other payment which the member would otherwise be entitled to receive from the EBF.
Failure to notify the EBF of a legal separation or divorce may result in a collection against the member (or suspension of a member's benefits) if an ex-spouse improperly continues to use EBF benefits.
In the event that you become legally separated you may remove your spouse from coverage. A copy of the separation agreement (The first page(s) stating the legal proceedings are a legal separation) as well as the fully signed and dated signature page(s) must be provided to the EBF, along with a completed Remove Dependent Form
If you become divorced, you are required to notify the EBF upon completion of the fully signed divorce decree. A copy of the divorce decree (The first page(s) stating the legal proceedings are a divorce as well as the fully signed and dated signature page(s) must be provided to the EBF, along with a completed Remove Dependent Form
A name change can occur for different reasons.
If you have recently married and would like to update your name, please complete an EBF Enrollment Form
If you have recently married and would like to add your spouse if you have family coverage, please complete an EBF Enrollment Form
and send in a copy of your marriage certificate.
If you have recently divorced, please complete a Remove Dependent Form
, update your last name, and attach a copy of the divorce decree. Only send the first page stating that the decree is a divorce as well as the signature pages.
If you have legally changed your name for any other reason, please complete the EBF Name Change Form
and attach documentation from the court updating your name.
Yes. The EBF's dental plan has been reviewed by accredited ACA experts and has been determined to be fully compliant with health care reform provisions. The provisions that specifically relate to the EBF are the pediatric dental requirements affecting the claims of dependent children up to age 19. The EBF has taken all of the required steps to be compliant with the dental requirements that took effect for cases initiated after January 1, 2014. The CSEA EBF is fully compliant with the pediatric dental requirements of the ACA.
The EBF has a guide for HBA's that will assist them and answer any questions they have regarding the EBF. The guide can be downloaded here
The EBF calculates the fair market value of benefit payments made for domestic partners or anyone that is not a dependent as defined by the Internal Revenue Service. This is also known as imputed income.
When a 1099 is applicable, the EBF makes this calculation in January for the previous year. It is sent by January 31st automatically to the address of the member on file.
You should consult your tax professional (accountant, tax service, tax software provider, etc.) for questions about the 1099 when working on filing your taxes.
Judgements regarding a provider's quality of work can be very personal and individual. The Fund does not recommend providers to our members and does not render opinions or have the authority to make any evaluation regarding a provider's quality of work. The Fund does not verify, endorse, or refute the opinions of a dentist reviewing another's work.
If you go to a participating vision provider and select a frame from your plan collection, you will have no out-of-pocket expense for the cost of your frame. If you choose a frame that is outside of your plan collection, you will be provided a $30 allowance and you must pay the difference in the price to the participating provider.
Members and eligible dependents who wish to purchase lenses and coatings not currently covered by their vision program may be entitled to a fixed co-pay schedule at a participating provider's office. Please consult your specific plan book for details.
Yes, EBF offers a Retiree Dental Program to retirees who were previously covered by an EBF dental plan. Members meeting eligibility criteria have a maximum of 90 days from their retirement date or COBRA expiration to elect the EBF Retiree Dental Plan. Participants pay a monthly fee. Participating dental providers accept the Retiree Dental Plan as payment in full for covered services.
Yes. EBF offers a Retiree Vision Program to retirees who were previously covered by an EBF vision plan. Members meeting eligibility criteria have a maximum of 90 days from their retirement date or COBRA expiration date to elect the EBF Retiree Vision Plan. Participants pay a monthly fee for this program. A national provider network of over 10,000 participate in the Plan.
Yes – Enrollees and any eligible dependents are required to stay on for a minimum of 12 months from their initial enrollment date unless a qualifying event occurs.
In addition to dental and vision benefits the EBF offers Hearing Aid, Legal, Maternity, Prescription Drug Co-Pay and Physician Co-Pay benefits that must be negotiated by an employer for its members.
Members whose employers have negotiated Reimbursement Benefits in their contract.
All of our forms can be downloaded through our "Download Forms" button located on the home page. Here is a direct link
. Due to the time sensitivity regarding the filing of claims please contact us at 800-323-2732 if you have any questions.
You should receive your payment within 4-6 weeks upon receipt.
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.
Contact your local pharmacy and/or mail order company and ask for a complete, itemized printout for yourself and all eligible dependents. The printout must contain the patient's name, prescription name and co-pay charged.
Contact your health insurance carrier and ask for EOB's for all eligible dependents or log into your online health insurance account and print the EOB's yourself. If you have CDPHP, please click here
for a step-by-step guide to printing your EOB's.
Dependent Coverage for a Child
The Patient Protection and Affordable Care Act required employers and insurers to implement changes in health care benefits and eligibility for coverage. One provision of the Act permitted adult children to remain on their parent's health plan until age 26. A provision of New York state law extended that even further. Dental and Vision benefits are not affected by the changes in the Federal Law. The CSEA EBF plan provides coverage for dependent children from age 19 to age 25 if the child remains in full time student status. The EBF requires that current proof of student status be provided annually in order to qualify for benefits.
You can submit student proof online from a desktop or laptop computer by clicking here
or through the Enroll Online button on the home page.
Live Chat allows our members to communicate directly with a CSEA EBF Senior Benefits Specialist and Customer Service Representatives via the Live Chat button on our website. Due to the high volume of online inquiries please try to keep your questions as concise as possible.
CSEA can be reached at www.cseany.org
Live Chat can answer basic questions about the EBF and its plans, send contact links for our dental and vision books and forms. Live Chat can also send links to other contact businesses such as Pearl Carroll & Associates and other departments within CSEA.
Questions that require technical answers for specific plan questions.
Including topics such as: What is the remaining amount of a dental maximum, predetermination/claim status, eligibility dates, eligibility for specific services, patient eligibility, plan rates.
Our dedicated Member Services Department and Dental Department are available at 800-323-2732 press 5 press 4 to assist with these questions. Member Services handles member enrollment and eligibility, vision, and reimbursement benefits questions. The Dental Department handles all specific dental questions. The COBRA/Retiree department can assist with questions about availability of COBRA or Retiree benefits to those that qualify for coverage or those members currently using the plans.
Questions regarding insurance coverage from other carriers cannot be answered by Live Chat. Please contact the carrier directly.
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