The benefits provided by this Fund may be changed by the Board of Trustees at anytime, in their sole and absolute discretion. The Board of Trustees adopts rules and regulations for the payment of benefits. All provisions of the Benefit Reference Guide (BRG) are subject to such rules and regulations and to the Trust Agreement, which established and governs the Fund operations. All benefit and eligibility rules are uniformly applied by the Fund office and Third-Party Administrators. The actions of the Fund or its Administrators are subject to review by the Board of Trustees.
A member or beneficiary may request an APPEAL of any action 180 days of the last determination.
All Appeals for Vision, Tax and Retiree Basic Plan must be in writing addressed to:
The Board of Trustees
SCME Benefit Fund
30 Orville Drive, Suite D
Bohemia, New York 11716-2513
All Appeals for Dental must be in writing addressed to:
333 Earle Ovington Blvd., Suite 300
Uniondale, New York 11553-3608
Since the Fund is no longer self-insured, the Board no longer has the ability to grant appeals to anyone on the Fully-Insured Plans (Excludes No-Cost Basic Retirees & Basic Retiree Cobra Members). All appeals must be made directly to Healthplex pursuant to their procedures, which are listed on the denial letter received by the member. The member should immediately check the date of their denial letter and file within the required 180 days.