Unified Court System
The Unified Court System (UCS) Full Time plan allows UCS Full Time members and their eligible dependents to one examination, one pair of glasses (lenses & frames). Contact lenses covered under the plan will now include Planned Replacement and Disposable lenses. A contact lens formulary will now be included and will be used for the initial supply of many of the popular and commonly prescribed brand of soft contact lenses. Members and dependents are eligible once every 12 months.
The UCS Full Time Plan offers the Premier frame line and consists of approximately 300 frames in various designer styles and colors. Lenses include single vision, bi, trifocal, cataract, fashion tints, and prescription sunglasses. The benefit also includes progressive addition (standard & premium, no-line bi and trifocals, high index, scratch guard, polycarbonate lenses and glass photochromic.
If using a non-participating provider, reimbursements are made based on the fee schedule appearing in the Summary Plan Description provided to the member. Reimbursement is made on one pair of eye wear per person. Both services must be provided at the same time.
This plan is for employees in the Unified Court System Full Time bargaining unit represented by CSEA. If you were an employee of the CSEA represented State of New York UCS Full Time bargaining unit and retired on or after April 1, 1998 you may be eligible for continued UCS benefits. Whenever the estimated cost of a recommended dental treatment exceeds $500.00 it must be submitted to the Employee Benefit Fund before work begins.
Members of the UCS Part Time bargaining unit represented by CSEA may be entitled to the Sunrise Dental Plan. Your Health Benefits Administrator can provide assistance with questions about determining your eligibility.
Legal Services Benefit
This benefit provides assistance with meeting legal expenses for members of the UCS Full Time bargaining unit. Members are free to choose any attorney according to individual needs and type of case. Reimbursement is sent directly to the member.
Limitations and Exclusions
- $1,000 per calendar year (January 1 - December 31) per family.
- Members are reimbursed for legal expenses only to the extent of fees charged and up to the identified maximum for each service. It is important that you discuss with your attorney the estimated charges before you commence any legal work. Charges over the allowances are the responsibility of the member.
- Once you decide to retain legal counsel, you may be required to make an initial payment.
- If a court awards full or partial payment for legal fees, the Fund's payment of allowances shall be reduced by that amount awarded-total will not exceed the amount charged by the attorney.
- Costs of document reproduction, filings, court fees, etc. are not covered nor are second opinion fees.
- Only matters specified in this brochure are covered. Additional exclusions are listed in the General Exclusion section of this Plan.
- You cannot claim services if your represent yourself.
The Attorney's original bill must be attached to the voucher and forwarded to the Fund Office. Write or call the Fund Office for a legal voucher (800) 323-2732 or CSEA EBF, 1 Lear Jet Lane, Latham, NY 12110.
A member of the UCS Full Time bargaining unit can receive the $200 benefit if either the member or the member's wife/domestic partner has a child. Write or call the Fund Office to obtain a Maternity Benefit Claim Form.
Prescription Drug Co-Pay Benefit/Physician Co-Pay Benefit
The Prescription Drug Co-pay and Physician Co-pay benefit allows the member of the UCS Full Time bargaining unit to combine co-pays for covered prescription and physician office visits. This means you can submit a maximum of $325 in Prescription Drug Co-pays or $325 in Physician Co-pays or any combination of both with a maximum annual reimbursement of $325. Only one claim will be processed per calendar year.
Complete the claim form and submit it with your itemized pharmacy printout and/or Explanation Of Benefits (EOB) from your health insurance carrier in one combined claim, when you have reached the maximum benefit of $325 for the current calendar year. If you do not accumulate the maximum allowed, submit your claim after December 31 for what you did pay. Deadline for claim submission is March 31 of the following year.
Hearing Aid Benefit
Members of the UCS Full Time bargaining unit can submit for up to $150 per ear once every three calendar years towards the cost of a hearing aid, including charges for its fitting upon the recommendation of a physician or otologist. Submit your completed form with your paid bill and a copy of your doctor's prescription to the Fund Office. The fund does not pay for any repairs, replacement batteries or any appliances or expenses not recommended or approved by a physician or otologist.
Workplace Security UCS Full and Part Time
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. 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 extend of injuries and proof of immediate medical attention. The plan will use the NYS Penal Law, Article 120 as the guidelines for determining assault for all claims.