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New York State provides vision and dental benefits at no cost
to employees who meet the eligibility requirements for
participation in the New York State Health Insurance Program.
These benefits are available to you and your eligible dependents
whether you enroll for individual or family coverage in the
Health Insurance Program or decline health insurance coverage.
Dental and vision care coverage is not automatic; you must first
enroll yourself and your dependents.
Detailed information about eligibility requirements for you and
your dependents, covered benefits, and instructions on how to
use your plans may be found at
http://www.cs.ny.gov/ebd/welcome/login.cfm Briefly, the
plans offer the following benefits:
DENTAL CARE
EmblemHealth (GHI) Preferred Dental Plan
PO Box 12365
Albany, NY 12212
www.ghi.com
Group # 954
1-800-947-0101
Management Confidential professional employees are eligible for coverage
the first of the month following 6 calendar months of
employment.
Eligible members and dependents are covered for two routine
examinations and cleaning of teeth and four bitewing x-rays per
calendar year. Other procedures will be covered following a $25
per person per year deductible. Total Family deductible will not
exceed $75 per year for all covered family members. The amount
credited towards the deductible is based on EmblemHealth (GHI)’s Schedule of
Allowances, not the amount charged by the dentist or physician.
Dental Services rendered by participating and non-participating
providers are covered to the extent that they are a covered
service, are necessary for dental health, and are performed by a
licensed dentist or physician. When covered services are
rendered by non-participating providers, you are reimbursed
based on the Reimbursement Schedule. When rendered by
participating providers, these dental services are covered on a
paid-in-full basis. Dependent children who are age 19 or older,
but under age 25, are eligible if they are full-time students.
Student verification will be required.
VISION CARE
Davis Vision
711 Troy Schenectady Road
Latham, NY 12110
www.davisvision.com
1-888-588-4823
Management Confidential professional employees are eligible for coverage
as soon as they complete a 56 day waiting period. Coverage
becomes effective on the 57th day.
Eligible members and dependents age 19 and older are entitled to vision services
once every 24 months (from the last month of benefits received).
Dependent children who are age 19 and older, but under age 25,
are eligible if they are full-time students. Student
verification will be required. Dependents under age 19 are
covered once in any 12 month period. When using a network of
participating providers, the benefit includes an eye exam and
one pair of glasses without co-payment (from a select frame
assortment) or plan-covered contact lenses with either a $25 or
$45 co-payment (based on the brand of contacts selected). A list
of participating providers is available from Davis Vision. If
you choose to use a non-participating provider, you will be
eligible for a partial reimbursement towards the cost of your
exams, glasses, frames or contact lenses.
Davis Vision Form
Laser Vision Form
HOW DO I ENROLL?
To enroll, complete the dental and vision portion of the
Health
Insurance Transaction Form (PS404)
and return the completed form to the Employee Benefits Office,
Cleveland Hall 410.
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