Suffolk County Municipal Employees Benefit Fund

  

   

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, 2007, 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.

 
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 2006  prescription co-payments (2006 claims are no longer eligible after 12/31/07), 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, social security 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 02/28/2008