State Vision Plan
When using a participating provider, the State Vision Plan allows members and their eligible dependents to have an eye exam (which includes dilation if your provider determines it is necessary) and to receive glasses (lenses and frames) or contact lenses. The Plan offers the Premier frame line which includes approximately 300 frames in various styles and colors. The lens selection includes standard single vision, bifocal and trifocal eye glass lenses as well as standard progressive addition lenses, photochromic lenses and scratch proofing. You can also opt for prescription sunglasses instead of a pair or regular wear glasses or contact lenses. The contact lens selection consists of soft standard daily wear, planned replacement or disposable lenses. Members, spouses/domestic partners and dependent children age 19-24 (if a full-time student) are eligible for a service once every 24 months. Dependent children under age 19 are eligible every 12 months from the last usage.
A Video Display Terminal (VDT) benefit is also available as part of the regular service. Members whose job duties require 50% or more of their work hours on a VDT are eligible to receive a 2nd pair of glasses if a different prescription and/or tinting is needed for computer use.
At the time of your regular service, you can also take advantage of a "fixed co-pay" program which will allow you to purchase extras that aren't covered on the plan. These include anti-reflective coatings, UV coating, Polarized lenses, high index lenses, plastic photosensitive lenses like Transitions and premium progressive lenses like Verilux.
If you should choose to obtain your exam and glasses from a non-participating provider, a reimbursement based on a set fee schedule is available. The reimbursement can only be applied to one pair of glasses or contacts.
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 a $2,850 a year annual maximum on dental benefits available to each member and dependent(s). Orthodontic benefits are available for eligible dependents under the age of 19. Whenever the estimated cost of a recommended dental treatment exceeds $500, we recommend that your dentist submit to the EBF for a pre-authorization before the work begins. A pre-authorization is not a guarantee of benefits. Payment is always subject to eligibility at the time of service.
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 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 $150 per family* per calendar year. To obtain the maximum benefit of $150, members must wait until their co-pay expenses reach $450 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 $450 before filing your claim.
- If you do not accumulate $450 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 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.
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.
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 400% of the assault benefit payable.
- 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.