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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.


EBFBenefits

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.

The EBF is committed to protecting the personal medical information it collects from its members during the regular course of business. To download a copy of our updated Privacy Policy please click here.

No. Your union dues do not pay for your dental and vision benefits with the CSEA Employee Benefit Fund. These benefits are negotiated on your behalf with your employer and provided pursuant to the CSEA contract.

Members whose employers have negotiated for EBF benefits in their collective bargaining agreement.

State Employees : Click Here
Unified Court System Employees : Click Here
Local Government Employees : Vision Benefits and Dental Benefits
Still not sure? Use our Search Benefits Tool to find what benefits you're eligible for.

After your employer informs the EBF that you are eligible for EBF benefits, a "Welcome Aboard" package is sent to you 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. A direct link is located here.

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. A direct link is located here.

Participating providers agree to accept EBF payments for covered services as full payment for most services.

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 1-800-323-2732 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. This claim form should be available at your provider's office. 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 at: CSEA EBF Dental Claim Form

The EBF accepts electronic claims from Change Healthcare, Tesia, and DentalXChange clearinghouse. Our payor number is CX054.

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, EBF ID#, 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 Download Forms and select "Vision Care Reimbursement Form" from the menu. 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 and press 5 on the phone menu for a customer service representative in the Member Services Department.

To change your address with the EBF, please complete our online Change of Address Form OR call the Member Services Department directly at 1-800-323-2732 and press 5 on the phone menu to update your information.

To order a replacement ID card, go here. 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 processing will take 5 to 7 days to arrive. There is no charge for replacement ID cards and your number will not change.

State EBF Members: 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 EBF Members: 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. Coverage terminates based on the termination date the employer provides.

State EBF Members
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. 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 EBF 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.

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.


Previously, if you were married in a jurisdiction that allows same-sex marriage, you were able to enroll your spouse in the CSEA EBF. That remains the same now. To enroll your spouse, download the CSEA EBF enrollment form and complete the applicable sections. When sending the form to us, please include a copy of your marriage certificate as proof of the location you were married.

You should consult your tax advisor as to how the benefits provided to your spouse will be treated for purposes of Federal and New York State income tax.

The CSEA EBF strives to provide quality benefits to eligible CSEA members and their dependents. If the EBF determines that a CSEA member, or a dependent of a CSEA 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.

In the event that you become legally separated (a) by living separate and apart from your spouse pursuant to a written agreement of separation or (b) by the issuance of a decree of legal separation, you may remove your spouse from coverage. A copy of the fully signed and dated separation agreement or the separation decree signed by the Court, whichever is applicable, must be provided to the EBF in order to remove your spouse. If you become divorced, you are required to notify the EBF within five business days of the date of the divorce decree. Failure to notify the EBF of a divorce within such five business day period 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.

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 enrollment form and send in a copy of your marriage certificate.

The Enrollment Form is located here.

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.

The Remove Dependent Form is located here.

If you have legally changed your name for any other reason, please complete the EBF Enrollment 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 the new 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 new 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.

 

Vision Benefits

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 are entitled to a set co-pay schedule. Please consult your specific plan book for details.

 

Retiree Benefits

Yes, we have a Retiree Dental Program available 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. CSEA members who were covered by an EBF vision program and retire on or after June 1, 2016 may be eligible for participation. A separate Retiree Vision Memorandum of Agreement must be signed by the employer and in place on the date of retirement to access this program. Members meeting eligibility criteria have a maximum of 90 days from their retirement date to elect the Retiree Vision Program. A national provider network of over 10,000+ participate in the program. Participants pay a monthly fee for this program.

 

Co-Pay Reimbursements & Other Miscellaneous Benefits

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:
Prescription Drug Co-Pay - $150 per family, per calendar year - Download Form

New York State Employees are not eligible for miscellaneous benefits.

Combined prescription/physician co-pay - $325 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

Part-time Unified Court System employees are not eligible for miscellaneous benefits.

Prescription drug co-pay - $100 per family, per calendar year - 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

Hearing Aid Benefit - $450 per ear/3 years - Download Form

Legal Benefit - $1,000 annual benefit - Download Form

Hearing Aid Benefit - $450 per ear/3 years - Download Form

Prescription drug co-pay - $200 per family, per calendar year - 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

Hearing Aid Benefit - $450 per ear / 3 years - Download Form

Hearing Aid Benefit - $450 per ear / 3 years - Download Form
Legal Benefit - $1,000 annual benefit - Download Form

Prescription Drug Co-Pay - $100 per family, per calendar year - Download Form

Hearing Aid Benefit - $450 per ear / 3 years - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Maternity Benefit - $200 per child - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form

Hearing Aid Benefit - $450 per ear / 3 years - Download Form
Prescription drug co-pay - $200 per family, per calendar year - 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

Hearing Aid Benefit - $450 per ear / 3 years - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form
Maternity Benefit - $200 per child - Download Form
Legal Benefit - $1,000 annual benefit - 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

Hearing Aid Benefit - $450 per ear / 3 years - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Maternity Benefit - $200 per child - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form

Prescription drug co-pay - $500 per family, per calendar year - Download Form
Physician co-pay - $120 per family, per calendar year - Download Form

Prescription drug co-pay - $500 per family, per calendar year - Download Form
Physician co-pay - $120 per family, per calendar year - Download Form

Hearing Aid Benefit - $450 per ear / 3 years - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Maternity Benefit - $200 per child - Download Form
Prescription drug co-pay - $200 per family, per calendar year - Download Form

Hearing Aid Benefit - $450 per ear / 3 years - Download Form
Legal Benefit - $1,000 annual benefit - Download Form
Maternity Benefit - $200 per child - Download Form
Prescription drug co-pay - $200 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
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

Hearing Aid Benefit - $450 per ear/3 years - Download Form
Legal Benefit - $1,000 annual benefit - Download Form

Prescription drug co-pay - $250 per family, per calendar year - Download Form

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.

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 federal health care reform act required employers and insurers to implement many 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.

 

Live Chat

Live Chat allows our members to communicate directly with a trained CSEA EBF customer service representative 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.

Live Chat can answer basic questions about EBF dental and vision 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 such as the balance left on a dental cap, the status of a dental claim or predetermination, eligibility for specific services under a Fund sponsored program or status of payment of the Rx Co-pay Benefit cannot be answered by a Live Chat operator. Live Chat cannot verify patient eligibility. Questions regarding insurance coverage from other carriers such as Pearl Carroll or GHI cannot be answered by Live Chat. Please contact the carrier directly.