Suffolk County Municipal Employees Benefit Fund

April 28, 2009

Dear Members,

 By now, you should have received your new SCME Benefit Fund identification card.

A second set of cards with the member’s name and identification number is being mailed for your   spouse’s use. A third card for children 18 years of age and older is also being mailed with the member’s name and identification number. Identification cards will not be issued for children under 18 year’s of age. As they are minors, parents must continue to contact the Fund to secure benefits on their behalf.

You can request a duplicate identification card by accessing the Healthplex, Inc. website, www.healthplex.com, and following the links.

When making dental appointments, please give your new ID numbers to your providers and advise them they will need to use this number to verify eligibility.

Thank you for your cooperation.

Sincerely,

Cheryl A. Felice

Chairperson

March 18, 2009

 Dear Members,

New Benefit Fund ID Cards

The Benefit Fund Trustees are improving the delivery of services for dental care by processing dental claims through a third party provider.  Healthplex is a well known agency who are experts in processing dental claims promptly. 

New ID cards will be mailed shortly and will contain, for the first time, a Benefit Fund member ID number.  This number will be used on all Benefit Fund Claims and Vouchers and will replace the need to use of your social security number.  We know that creating alternate ID numbers will help protect you and your family from threats of identity theft. 

On behalf of all Trustees, we are please to bring these improvements to you.

Sincerely,

Cheryl A. Felice

Chairperson

It's that time of year again! The beginning of a new year when you start out fresh with new maximums on your dental benefits, you can file for your 2008  prescription co-payments (2008 claims are no longer eligible after 12/31/09), your annual optical benefit becomes available again and tax time  is right around the corner.

Here are some hints to help you on your way:

          OPTICAL & TAX CERTIFICATES

1. If you can't get through on the telephone to request your optical and tax vouchers, try using the online certificate  requests.  Just click on the link, follow the directions and your  certificate will be on its way to you. 

2. Try calling the Fund before or after business hours. (The Fund is open 9am to 5pm, Monday through Friday).  The Fund's automated voicemail will take your call and all you have to do is leave a message stating the type of voucher you need (optical or tax), your name, Benefit Fund ID number, who in your family you want the certificate for and a daytime phone number you can be reached at in the event that part of your message can't be understood.   Your certificate (s) will be issued the next morning when all of the voice messages are transcribed.

Due to the number of certificate requests that we get at the beginning of each year, we print and mail them every day.  If you don't get your certificate within 7 days, contact the Fund.  It's possible that some or part of your message was inaudible, making it impossible to issue the certificate or contact you for additional information.  To avoid this, make sure that you speak clearly and as briefly as possible without any background noise interference.

Don't request a certificate unless you plan to use it right away.  There is a 60 day expiration on the certificate, so if you don't have an immediate need,  hold off your request.  Help us control our costs by only making your request  when you plan to visit the optician or accountant.

PRESCRIPTION CO-PAYMENT REIMBURSEMENT

1. Don't send  in your prescription co-payment claim form until you receive your annual statement from your primary prescription plan.  All too often our members find something on that statement that they forgot to put on their claim form.  The Fund has a one-claim-per-year rule, so you can't amend your form once you've already sent it off to the Fund.  You can download the Prescription Co-payment Reimbursement claim form by clicking here.

           BENEFIT ELIGIBILITY

1. Keep your college-aged children's benefits continuous - remember to send in their college proof !  You can download the necessary form by clicking here.

That's it for now!  

Updated 04/29/2009

BENEFIT ENHANCEMENTS ANNOUNCED FOR 2008

We are pleased to advise you of the dental plan changes went into effect on January 1, 2008.

Effective January 1, 2008, the Fund provides dental benefits for implant crowns (ADA codes 6052—6073)

at an allowance at $500 each. These crown benefits will be deducted from the members’ annual general dentistry benefit maximum of $2,250. Please be aware that participating providers can charge the patient their usual and customary fees which will give you, the patient, an out of pocket expense.

Secondly, effective January 1, 2008, is the addition of dental coverage for surgical implants (ADA codes

6010, 6040 and 6050). The Fund will institute a new lifetime maximum of $2,000 for the actual implants, allowing

up to $500 per implant.

Effective January 1, 2008, the Fund provides dental benefits for occlusal guards (ADA code 9940) at a

reimbursement level of $225 once every five (5) years.