Dental

May 8 2018

Dental Benefits: CSEA EBF, dental benefits.#Dental #benefits

Local Government Dental Benefits

Over 2,200 participating dental offices in New York State. You may use any licensed dentist for dental care. The following plans are available for Local Government.

Available Plans

  • Sunrise – The Sunrise Dental Plan offers a $2,850 per person annual maximum on regular dental work.

  • Horizon – The Horizon Dental Plan offers a $3,000 per person annual maximum on regular dental work. The fee schedule is higher than the Sunrise schedule.

  • Equinox – The Equinox Dental Plan offers a $3,210 per person annual maximum on regular dental work. The fee schedule is higher than that of the Sunrise and Horizon schedules. The Equinox Plan also covers adult orthodontics which is not currently covered under the Sunrise and Horizon Plans.

  • Dutchess – The Dutchess Dental Plan is our premiere plan and offers an annual maximum of $3,210 per person for regular dental work. Dutchess reflects higher fees when compared to most Equinox services. The Dutchess plan also covers adult orthodontics.

  • Retiree Dental – The Retiree Dental Plan is available to retirees who choose to pick up coverage within 90 days of their termination date. This benefit is available to all State employees and Local Government units if negotiated in their collective bargaining agreement. This coverage is only available to retirees who were previously covered by another Fund dental plan. The Retiree Dental Plan offers an $1,800 per person annual maximum on regular dental work.

    Participating Providers

    Participating providers have agreed in writing to accept the CSEA EBF Fee Schedule as payment in full for services covered by our dental plans. However, if a member requires treatment from a specialist in a participating general dentistry practice, he/she will be informed of the specialist’s right to balance bill. The member will be responsible for the difference between the specialist’s customary charge for the service and the allowance which the CSEA EBF pays under the member’s dental plan. Members choosing a non-participating dentist are reimbursed according to the fee schedule which appears in the Summary Plan Description provided to the member. Although our recruitment process of providers into the EBF is ongoing, participation is at the sole discretion of the dentist.

    Specialists

    Oral Surgeons, Endodontists, Periodontists who are part of participating general practices have the right to bill members the difference between the specialist’s customary charge for the speciality service and the allowance paid by the applicable CSEA Employee Benefit Fund dental plan.





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