Benefit Plan Information

PVFT Welfare Trust Fund provides Dental and Vision Benefits for its plan members.  All CSEA members whose position is designated more than 30 hours a week or PVFT members whose position is designated .5 FTE or more are eligible for benefits while employed or retired from the Putnam Valley Central School District. Retirees have the option to join the fund within the first 6 months of retiring from the district.

A summary of Benefits can be viewed below.  Please refer to the Full Plan Benefit Document attached at the bottom of this page for more detailed information.

Special new information regarding Orthodontic reimbursements:

Effective  July 1, 2022

Orthodontia reimbursement will be paid based upon the schedule below:

• $500 for placement to the orthodontist

• $250 payment per month for 12 months to the orthodontist

• In total, $3500 will be paid to the orthodontist

If the orthodontist has completed their services and you the member did not receive the full $3500 benefit from the Welfare Trust Fund, the member will submit an appeal to TPG explaining this scenario, and request the balance due of the unused $3500 orthodontic benefit from the fund. Include all EOBS and payment information showing the contracted amount, payments made, and balance due. After the appeal is reviewed and approved by the Trustees, a payment will be sent directly to the member for the remaining amount. Otherwise, your provider will continue to received their $250 each month until the $3500 is paid out to the provider.

See, "How to submit an Appeal" on the Home Page of this site.

 PUTNAM VALLEY FEDERATION OF TEACHERS WELFARE FUND

SUMMARY OF BENEFITS FOR ACTIVE EMPLOYEES (RETIREE INFORMATION LINK BELOW)

Last updated: August, 2023

You, your legal spouse , and your legal dependents are eligible for coverage in accordance with the rules and regulations of the Putnam Valley Federation of Teachers Welfare Fund. 

• Your coverage becomes effective on your date of employment.  Some dental procedures have a 1 year waiting period.

• Your plan year is from January 1 to December 31.

• You may use your own licensed provider or the dental providers available to us who participate with the Anthem 100/200/300 Blue plan.  See here for information.

• All claims must be submitted within 90 days of the close of your Plan year, that is, by March 31st.

• The Plan Administrator information, can be found at the Home Page of this site.

Family Leave, Sabbatical Leave considerations:

Any member of the Trust granted a leave of absence by the Board of Education after at least one year of continuous membership in the Trust, may maintain his/her membership through direct personal payment to the Trust. Payment will be required in full within 30 days of the last day worked, and will be equal to the amount that would have been due from the Board of Education. In the event payment is not received within 30 days, membership will be terminated. If membership is not maintained, the member, upon return, will be subject to all rules affecting new members. Teachers who extend their Family Leave Act time are subject to these guidelines.

DENTAL PLAN

Time restrictions apply to certain procedures. Please consult the Covered Dental Services section of the Plan Full Benefits/Trust Document.  Link below.

 New members have a one year waiting period for the following:

1. 1. 1. Bridge and Crowns

      2. Orthodontia

      3. Periodontal (Osseous) Surgery

      4. Dentures

Any employee who has met the first year major work requirements will have to wait only 6 months to receive benefits for major work if that employee leaves the district and is subsequently rehired.

You must submit a pre-treatment estimate for any claim for the following services: Anesthetics, Extractions and Oral Surgery, Crowns/Onlays and Inlays, Periodontics, Root Canal Therapy, Prosthetics, Implants.  See this link for more information.

Coordination of Benefits:

If you and your spouse each have coverage, your dependent children will be considered primary by the plan of the person whose month and day of birth occur earlier in the calendar year.

When you submit claims for members of the family who are primary through another carrier, a copy of the primary plan’s payment must accompany the claim.

Amount of Benefits:

The amount of benefits available to you for specific procedures will be in accordance with the schedule of fees adopted by the Trustees.

Benefits payable to an eligible participant and dependents are:

                   $2,000 per individual/$4,000.00 per family in any one plan year.

Once the dental maximum has been reached, you are responsible for any extra charges for that calendar year.

The maximum lifetime benefit for orthodontic treatment is $3,500.00

Placement = $500.00 Monthly Maintenance = $150.00/month.

Adults are not covered for orthodontic treatment. This benefit is only available to children under the age of 19. 

You are entitled to two (2) cleanings per year.

There is a $50.00 dental deductible per person for basic and major dental services per calendar year. There is no deductible for standard cleanings for each of your two cleanings per year.

VISION PLAN

The maximum reimbursement is $300.00 per year..  The vision benefit will cover the member and/or immediate family member, once per calendar year. For example; you may get glasses in August and again in January of the following year.

Members will be reimbursed for services by the plan administrator. The $300.00 vision benefit can be split between the member and their immediate family but that the total reimbursement will be $300.00 per calendar year.

You may go to your own licensed optical provider and you may use the services of Raymond Opticians (http://www.raymondopticians.com)