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State Benefits

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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.

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 event or the date on which coverage would be lost because of the event.

Prescription Drug Co-Pay Benefit

Download Co-Pay Form Here

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?

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.

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.

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.

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