|
Suffolk County Municipal Employees Benefit Fund |
|
|
|
Effective January 1, 2012, the Benefit Fund will no longer require members to provide the Fund with the prescription name you are submitting for the allowable co-pay reimbursement. The easiest way to accomplish this task is to sign onto the Express Scripts Website found at http//www.express-scripts.com and follow the steps below:
1. Create an online account (if you have not already done so) or sign in as a returning member; 2. This brings you to the “Welcome to Express Scripts” page, where you will click on the “My Prescriptions” heading in the left hand column; 3. This brings you to the “My Prescriptions” page, where you will click on “Prescription History” at the bottom of the list; 4. This brings you to the “Prescription History” page, where you will then click on the patient whose history you wish to print; then click on the date range you need; and then click on “Show History”; 5. This brings you to the actual “Prescription History” page where you will find a complete history of all the prescriptions you filled in the calendar year requested. There is a small box titled “Do not show drug names”. When you click this box, the word confidential will appear and you can then print your history to submit with your Prescription Co-Pay reimbursement form.
If you obtain a printout from your local pharmacy, inquire if their system has a confidentiality capability as Express Scripts. If the answer is yes, you may submit their confidential form. If they cannot withhold the prescription names, you may blacken them out.
Please be advised, if you use any printout other than Express Scripts, it must include patient name, fill date, third-party payment, member co-pay and you may only submit for prescriptions covered by the Fund. It is your responsibility to document any co-pay reimbursable drugs you paid for, because it will show a zero co-pay by the plan and will have a charge to the member. Your druggist may be able to assist you with this requirement.
* Note: This change in policy applies to 2011 and all future Prescription Co-Payment Reimbursements. |
|
-------------------------------------------------------------------------------------------------------------------------- Recently a mailing was sent to all members with dependents who are 19 years of age or older, for which the Fund does not have spring 2012 full time student verification. If your dependent is a full time student for the spring, please provide both a paid bill and a schedule or have the registrar’s office complete the student verification form that was enclosed. Should your dependent not be a full time student, you can opt for COBRA for 36 months at $43.19 a month or call Healthplex and buy into the CapDent plan they are offering. -------------------------------------------------------------------------------------------------------------------------- Effective 1/1/12 Dr. James Trentalange is no longer a participating orthodontist with the SCMEBF. He currently practices out of all Iannello Dental locations and his own office at 28195 Main rd., Cutchogue, New York. Therefore, all services rendered by Dr. Trentalange will be on an out of network basis. -------------------------------------------------------------------------------------------------------------------------- For a description of the recent mailing concerning the Retiree Self-Pay Plans please click here. For a copy of the letter or Enrollment form please click here. -------------------------------------------------------------------------------------------------------------------------- REMINDER All Vision Vouchers issued as of 11-1-11 will expire on 12-31-11 because this is a calendar year benefit. Your glasses must be ordered by 12-31-11 to utilize your 2011 Vision benefits. The Fund will be closed Friday, 12-23-11 through Monday, 12-26-11 for the Christmas Holiday. The Fund will be closed Monday, 1-2-12 for the New Year Holiday. Do to the fact the Fund will not be open on 12-31-11 and this is the last day for your 2010 Prescription Reimbursement claims to be dropped off at the Fund, these claims will be accepted until 5pm, Tuesday, 1-3-12. All claims being mailed MUST have a post mark of 12-31-11 or earlier to be eligible for benefits. -------------------------------------------------------------------------------------------------------------------------- Important Note - Notify the Fund Promptly of any Address Changes Please update us with any changes in your name, address, telephone numbers, or the addition of new dependents. Contact your personnel office, request and fill out a new enrollment card. Your completed card will then be forwarded to the Fund. If you are a retiree, please contact the Fund directly and request a new enrollment card. After completing the card, please return it directly to the Fund. If you have any questions or suggestions, please contact the Benefit Fund at 631-319-4099. -------------------------------------------------------------------------------------------------------------------------- The Fund will accept 2010 claims for processing at the Fund office until Monday, January 2, 2012 by 5pm. If you are mailing your 2010 claims, the rule "the envelope must be postmarked December 31, 2011" still applies. Please be advised that all claims are eligible for payment until the end of the following calendar year, HOWEVER, the services must be in incurred and completed while you are still an active employee of Suffolk County. This also applies to the Prescription reimbursement benefit. Claims do not have to be submitted prior to your retirement date to receive benefits. If you choose to file for the RX reimbursement before the 60 days are up for you to elect for COBRA or an Enhanced Plan you must state that you waive your rights to any further RX benefits for that year. --------------------------------------------------------------------------------------------------------------------------
|
|
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 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. 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 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 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 02/16/2012 |
|
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.
|
|
|
