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 through LiveChat or our Customer Service at 800-323-2732.
The CSEA Employee Benefit Fund (EBF) has been providing quality benefits at an affordable price since 1979. The EBF is a not-for-profit labor trust that offers dental and vision coverage as well as a select offering of reimbursement benefits to the CSEA membership and their families. The benefits are collectively bargained, and because of our structure, the benefits are priced as competitively as possible while still being able to maintain a strong network of providers.
To facilitate this mission, the EBF's Marketing Representatives are made available to attend Membership Meetings, Information Days, Health Fairs, Conferences and Workshops to assist our membership at their place of work.
Our Customer Service is available 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 and can be reached at 800-323-2732.
No. CSEA and the EBF are separate organizations. Your union dues do not pay for EBF benefits. EBF benefits are negotiated on your behalf with your employer and provided pursuant to your CSEA Collective Bargaining Agreement (contract).
CSEA Members whose employers have negotiated for EBF benefits as provided by your Collective Bargaining Agreement (contract).
If you are a current member of the EBF create an account and sign in to our Member Portal
to review your coverage.
After your employer informs the EBF that you are eligible for EBF benefits, a "Welcome Aboard" package is sent to you automatically with an enrollment form which must be fully completed and returned to the EBF. Eligible employees may also use the EBF Member Portal
to complete the form.
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.
Participating providers agree to accept EBF payments as full payment for most covered services. Non-participating providers can balance bill for any differences between what the plan pays for covered services and the provider's normal office charge.
You can call an EBF Customer Service Representative at 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 and other generic claim forms. A claim form should be available at your provider's office. Receipts are not accepted. 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 from the "Download Forms" section of our website or by clicking here: CSEA EBF Dental Claim Form
If you reside outside of New York State, please use the following guidelines for submitting claims to the EBF for reimbursement.
You can search for participating providers on our website by selecting the Provider Search
tool on the home page. Then choose "Dental" or "Vision" and select a State from the "State" pull-down menu. When the search is performed all providers from within the State you selected will be listed.If you reside outside of New York State, please use the following guidelines for submitting claims to the EBF for reimbursement.
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. Non-participating dentists can balance bill for any differences between what the plan pays for covered services and the provider's normal office charge. The EBF provides a list of providers outside of New York State who accept our dental plan fee schedule as payment in full for most services covered in the plan.
The EBF accepts the American Dental Association (ADA) claim form and other generic claim forms. A claim form should be available at your provider's office. Receipts are not accepted. 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, EBF dental claim forms are also available for download from the "Download Forms" section of our website or by clicking here: CSEA EBF Dental Claim Form
The EBF has many participating vision providers with locations in all fifty states, as well as in the District of Columbia and Puerto Rico. For member's who retire and have the option available to continue benefits under the EBF Retiree Vision Plan or COBRA, this means that your plan can be used in areas where the retiree has relocated. In addition, eligible dependent children and step-children who do not reside with the Member will now be able to have their regular eligible service in the area where they are residing. To save on out-of-pocket costs, it is recommended to use a participating provider when eligible for annual or bi-annual services under the plan.
To change your address with the EBF, please complete our online Change of Address Form through the EBF Member Portal
or call the Member Services Department at 800-323-2732 press 5 then press 4 to update your information.
Address changes for your CSEA Union Membership can be made by contacting CSEA Headquarters at 800-342-4146 or www.cseany.org
To order a replacement EBF ID card please use the EBF Member Portal
. Enter the required information and you can print your card right from the screen. You can also select to have a card mailed to you but it will take at least one week to arrive.
State EBF Members: You are covered for 28 days from the last day you worked. You may have certain rights to continue your coverage under COBRA. Unless you elect COBRA, dental and vision benefits terminate after 28 days. New York State notifies the EBF of your benefits termination date electronically.
Local Government EBF Members:Local Government employees must check with their Personnel Department to determine when benefits will end. You may have certain rights to continue your coverage under COBRA. Unless you elect COBRA, your benefits will end on the date submitted to the EBF by your employer.
Yes. As of 7/28/20 members who are termed by their employer due to deployment for active duty military service will be eligible for COBRA. COBRA payments ordinarily charged to the member to continue the EBF dental and vision benefits would be waived. The waiver is valid for the duration of the participant's military deployment and is suspended once that duty ends.
The EBF is not always advised of military deployments. It is important to contact your Health Benefits Administrator prior to your deployment so the waiver can be properly applied.
The EBF strives to provide quality benefits to eligible EBF members and their dependents. If the EBF determines that an EBF member, or a dependent of an EBF 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.
Failure to notify the EBF of a legal separation or divorce 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.
In the event that you become legally separated you may remove your spouse from coverage. A copy of the separation agreement (The first page(s) stating the legal proceedings are a legal separation) as well as the fully signed and dated signature page(s) must be provided to the EBF, along with a completed Remove Dependent Form
If you become divorced, you are required to notify the EBF upon completion of the fully signed divorce decree. A copy of the divorce decree (The first page(s) stating the legal proceedings are a divorce as well as the fully signed and dated signature page(s) must be provided to the EBF, along with a completed Remove Dependent Form
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 EBF Enrollment Form
and send in a copy of your marriage certificate.
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.
If you have legally changed your name for any other reason, please complete the EBF Name Change 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 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 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.
Judgements regarding a provider's quality of work can be very personal and individual. The Fund does not recommend providers to our members and does not render opinions or have the authority to make any evaluation regarding a provider's quality of work. The Fund does not verify, endorse, or refute the opinions of a dentist reviewing another's work.
To view your dental plan explanation of benefits (EOBs) and predeterminations online you need to create an online account through the EBF Member Portal by clicking the "I need to sign up" button.
Here's the direct link to the EBF Member Portal: portal.cseabf.com
Complete the form, login to your newly created account, and then click the "Get EOB's" tab.
You can then click on your name and then EOB's for processed claims and predeterminations for the last 5 years will be displayed.
Processing can take 2-4 weeks when a claim or predetermination is received and once processing is complete it will then be displayed.
HIPAA authorization is required before a member can view the claim of a dependent who is over age 18. When you click on the name of a spouse, domestic partner, or dependent child over age 18 you will be prompted to have them complete the online HIPAA form first before you are able to view their Protected Health Information.
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 $75 allowance and you must pay the difference in the price to the participating provider. Members covered thru the Unified Court System have a $150 allowance.
Members and eligible dependents who wish to purchase lenses and coatings not currently covered by their vision program may be entitled to a fixed co-pay schedule at a participating provider's office. Please consult your specific plan book for details.
Yes, EBF offers a Retiree Dental Program 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. EBF offers a Retiree Vision Program to retirees who were previously covered by an EBF vision plan. Members meeting eligibility criteria have a maximum of 90 days from their retirement date or COBRA expiration date to elect the EBF Retiree Vision Plan. Participants pay a monthly fee for this program. A national provider network of over 3,000 participate in the Plan.
Yes – Enrollees and any eligible dependents are required to stay on for a minimum of 12 months from their initial enrollment date unless a qualifying event occurs.
COBRA (Consolidated Omnibus Budget Reconciliation Act)
COBRA is a Federal provision that gives certain rights to employees to continue benefits at your expense for a maximum of 36 months in the event of a qualifying event: Termination of employment for any reason other than gross misconduct, layoff, Leave without pay or a reduction in hours. COBRA is offered in the event of divorce, legal separation or a child losing dependent status.
By Federal Law, participants have a maximum of 60 days from the benefits termination date to complete and return the COBRA election form to the EBF.
The EBF bills for COBRA benefits on a monthly basis. Payment is made directly to EBF.
Local Government Employees
If the EBF administers COBRA coverage for your employer, a COBRA election mailing will be sent upon receipt of your benefits termination date.
ARPA is a new law signed by President Biden on March 11, 2021. It includes a provision that subsidizes the full COBRA premium for “Assistance Eligible Individuals” for a special six month period.
The subsidy period starts April 1, 2021 and ends September 30, 2021.
A COBRA qualified beneficiary who is eligible for COBRA coverage and lost benefits due to a reduction in hours or an Involuntary Termination.
The former employer reports the information to the CSEA EBF.
Individuals who: voluntarily left employment (resigned); Retired; are on Medicare; or who have access to other group health insurance coverage, whether through another job or a spouse.
Yes. A qualified beneficiary whose qualifying event was a reduction in hours or an involuntary termination of employment prior to April 1, 2021 and who did not elect COBRA when it was first offered on or after 11/1/19 or who elected COBRA continuation coverage and dropped COBRA coverage may have an additional election opportunity.
YES. Qualified individuals must respond to the administrator mailing within 60 days of the administrator (EBF) notice. Pursuant to USDOL rules, the failure to respond within the deadline renders the individual ineligible for the subsidy.
NO. The Federal COBRA maximum of 18 months is counted from the individual’s ORIGINAL benefits termination date, not the start of the ARPA subsidy period.
Individuals may have the opportunity to continue COBRA coverage after the subsidy period has ended. All individuals will be notified of the subsidy end period and eligible participants will receive additional information regarding COBRA continuation.
In addition to dental and vision benefits the EBF offers Hearing Aid, Legal, Maternity, Prescription Drug Co-Pay and Physician Co-Pay benefits that must be negotiated by an employer for its members.
Members whose employers have negotiated Reimbursement Benefits in their contract.
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 upon receipt.
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.
Dependent Coverage for a Child (Effective 7/1/2020)
Effective July 1, 2020, the CSEA EBF has voluntarily adopted the dependent child eligibility guidelines set by the Affordable Care Act. Dependent children can remain on your CSEA EBF benefits until they reach age 26. If your child was previously enrolled and then “aged out,” they can now be added back. Please visit our Portal to initiate this process. Keep in mind that after 7/1/2020, your dependent children can stay on until the end of the month that they turn 26. Full time student status is no longer required.
As of 7/1/2020 Full time student verification is no longer required in order for your dependent to eligible under your coverage until age 26. Dependent children are eligible regardless of student status.
Prior to 7/1/2020, your biological children were eligible to be on your coverage regardless of where they lived. This remains the same under our new dependent child guidelines.
As of 7/1/2020, Dependent children are eligible for coverage up to age 26 regardless of marital status.
With our new policies effective 7/1/2020, step-children can be enrolled on your EBF benefits whether they live with you or not. Please visit our Portal to initiate re-submitting the necessary forms to add them. Under the new guidelines, step-children up to age 26 are eligible for coverage whether they are married or not.
Live Chat allows our members to communicate directly with a CSEA EBF Senior Benefits Specialist and Customer Service Representatives 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.
CSEA can be reached at www.cseany.org
Live Chat can answer basic questions about the EBF and its 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.
Including topics such as: What is the remaining amount of a dental maximum, predetermination/claim status, eligibility dates, eligibility for specific services, patient eligibility, plan rates.
Our dedicated Member Services Department and Dental Department are available at 800-323-2732 press 5 press 4 to assist with these questions. Member Services handles member enrollment and eligibility, vision, and reimbursement benefits questions. The Dental Department handles all specific dental questions. The COBRA/Retiree department can assist with questions about availability of COBRA or Retiree benefits to those that qualify for coverage or those members currently using the plans.
Questions regarding insurance coverage from other carriers cannot be answered by Live Chat. Please contact the carrier directly.
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