WebVDT Vision Rider (Available to the CSEA Member Only) Reimbursement Benefits: NYS Prescription Drug Co-Pay Reimbursement ; ATTENTION RETIREES: Dental & Vision Benefits May Be Available: Coverage must be elected within 90 days of retiree termination date or COBRA end date due to retirement. Select ... WebEmpire Plan Health Insurance Certificate - Detailed description of the benefits and plan requirements. Empire Plan Health Insurance Certificate Amendments. 2024 Empire Plan Advanced Flexible Formulary - Comprehensive Formulary - April 2024. 2024 Empire Plan Advanced Flexible Formulary - April 2024. Empire Plan Providers, Pharmacies and …
Products & Forms CSEA Member Insurance
WebJan 24, 2024 · CSEA Local 436. Now is the time to prepare for your prescription drug co-pay reimbursement from the CSEA Employee Benefit Fund. The EBF reimburses co-pays and other out-of-pocket costs for prescription drugs which are not covered by the member’s regular prescription drug plan once annually, up to a maximum of $300 per family per … Web1. Universal Enrollment Form (70k) The CSEA EBF Enrollment Form has been recently updated. 2. 2024 Prescription Drug Co-Pay (for NYS Employees) (64k) Note: Must also … DENTAL CLAIM FORM www.cseaebf.com 800-323-2732 Claim Address: PO Box … Recurring Payment Authorization Form ... CSEA EBF PO Box 516 Latham, NY … cseaebf.com confirmation from your employer. For purposes of IRS reporting it is necessary … 11. Vision Care Reimbursement Form (168K) - Download Forms : CSEA EBF 7. Prescription Drug Co-pay- NYS Liquidation Bureau (215K) - Download … Legal Plan Form (Pdf) - Download Forms : CSEA EBF MAIL COMPLETED FORM TO CSEA Employee Benefit Fund PO Box 516 … CSEA Employee Benefit Fund Enrollment Form Employee Information (Please … Frequently Asked Questions. Below are some answers to some common … fivesky.com
Co-Pay Reimbursement – CSEA Local 425
WebClaim Year _____ CSEA Employee Benefit Fund. 1-800-323-2732 www.cseaebf.com. MAIL COMPLETED FORM TO. CSEA Employee Benefit Fund. PO Box 516 Latham, NY … WebCO-PAY REIMBURSEMENT. 1 This book covers the NYS Administrative Services Unit, Institutional Services Unit, ... CSEA EBF at 1-800-323-2732 for a claim form or visit our website at www.cseaebf.com to download a form. EXCLUSIONS AND LIMITATIONS • All portions of the benefit (exam plus Webyour claim after December 31 for what you did pay. Allowed, submit your claim after Dec. 31 for what you did pay. Hearing Aid Maternity . Complete this claim form and submit with both your Complete this claim form and . Paid bill and a copy of the doctor’s prescription. submit with a copy of the child’s . Birth certificate. five skincare