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Suffolk County Municipal Employees Benefit Fund |
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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
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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
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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
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
BENEFIT ELIGIBILITY
That's it for now! Updated 04/29/2009 |
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BENEFIT ENHANCEMENTS ANNOUNCED FOR 2008
We are pleased to advise you of the dental plan changes went into effect on January 1, 2008.
Dental Implants & Crowns 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.
Please be advised that all of the above procedures require prior approval, as do surgical periodontia (ADA codes 4210, 4211, 4240, 4241, 4260, 4261, 4270 and 42710) and all orthodontia.
Occlusal/Night Guards 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.
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