Frequently Asked Questions...
Insurance Coverage
Q: Who does the NTA Member Benefit Trust cover?
A: Active NTA members, SRP secretarial staff, administrators and members of the CSEA bargaining unit. Benefits are based on one's contract.
Q: Who covers my medical insurance?
A: If you are eligible, the school district manages the NYSHIP/Empire Plan. Please call 1-877-NYSHIP if you have questions or please go to the District business office for assistance with status changes. You can find out more about NYSHIP by clicking here.
Q: We are moving and will be changing our address. Who should I contact?
A: Please contact the business office to make the change for NYSHIP/Empire and a trust manager to make the changes for the rest of your benefits.
Q: How does the Patient Care and Affordability Act impact the NTA Benefit Trust programs?
A: The dental and self-funded vision programs are unaffected by this law. The excess major medical plan is the only benefit that will allow coverage to age 26 regardless of student or job status.
Q: Are my dependents covered?
A: If your dependents are between the ages of 19 and 25 and a full-time student, they are covered for dental and Davis Vision. Forms are required to be filled out by the college registrar each semester in order for coverage to continue. The form is available on the "Benefit Forms" page and should be submitted directly to Preferred Group.
Dependents lose eligibility on their 25th birthday for the dental and self-funded vision plans regardless of student status. There is no 3 month extension of benefits beyond graduation if the student is graduating at age 25.
If you are opting for the NYSHIP/Empire Plan Young Adult Dependent program and you have family excess major medical coverage, then your dependents are eligible for the excess major medical plan (plan reimburses for deductible and coinsurance if seeing an out-of-network doctor). If you are paying for the NYSHIP/Empire Plan Young Adult Option, that dependent is eligible for excess major medical at their own expense. Please see a trust manager or the business office for more information.
Q: What are the calender years for our benefits?
A: Dental: January 1 - December 31
Excess Major Medical Supplemental Plan: January 1 - December 31 (follows the same plan year as NYSHIP)
Davis Vision: 1 year from date of last usage for both eye exam and eyewear. If you have the Enhanced Davis Vision Plan, you are eligible for TWO new pairs of glasses or sets of contacts.
**Claims for these services must be submitted by March 31st following the end of the plan year.
Q: Can part-time teachers participate in all/some benefits?
A: Yes. There are two options:
1. Pay the remaining balance of the FTE District contribution
through payroll deduction and you will have dental, vision,
excess major medical, $50,000 non-contributory life
insurance and health advocate.
2. If you do not elect to pay the remaining balance of the
FTE district contribution, you will have $50,000 non-
contributory life insurance and health advocate.
Based upon your part-time status, other benefit coverage will
be considered on an individual basis.
Q: How does payroll deduction work?
A: Part-time teacher fees, contributory life insurance, family excess major medical fees ($240 per year) and family dental/vision fees ($130 per year) are paid through 14 pay periods starting with the first pay period in November. Family excess major medical and family dental/vision fees are paid using pre-tax dollars. There is no additional charge for single dental, single vision or single excess major medical coverage.
Q: I am a new teacher/teaching assistant/SRP/Administrator. When does my calendar year start for dental and vision?
A: A new calendar year starts 16 months after employment.
NOTE: This applies to any new employee that participate in our self-funded dental and vision plans.
Q: When can I enroll in AFLAC or the FLEX 125 plans?
A: Each September.
NOTE: These plans are offered by the school district and NOT the NTA Benefit Fund.
Q: Am I still a member of NYSUT upon retirement?
A: Yes. Currently, no dues are expected from NYSUT retirees.
Q: Upon resignation, when does benefit coverage end?
A: Please see your contract.
Q: My spouse's son/daughter is coming to live with us. Are they eligible for benefits?
A: Yes, if you can provide proof of guardianship.
Q: I am part-time employee and pay for my dental, vision, and excess major medical insurance through payroll deduction. The district has recently increased my instructional time. Can I be reimbursed?
A: Yes. Please see the trust managers for the adjustments to be made.
Q: My future spouse is also an employee of the district. We presently both have single coverage. Once we are married, who should we contact to make the appropriate changes?
A: Contact the business office to make changes to NYSHIP/Empire. Contact a trust manager to make changes to all other benefits.
Dental
Q: What company provides my dental insurance?
A: Our dental plan is self-funded. The Preferred Group pays your dental claims using our funds.
Q: Why use a participating provider?
A: After meeting the $25 co-pay per date of service, participating dentists will accept payment from Preferred Group based on our fee schedule. THE EMPLOYEE IS NOT RESPONSIBLE FOR ANY OTHER CHARGES (unless the $2700 individual maximum has been reached). Any employee asked to pay, should call Melanie Hiller at The Preferred Group to have this corrected.
Q: The participating provider I used charged me for their services after I met the co-pay and I have not met any of my yearly maximum charges. What should I do?
A: Please contact either Chris Campanella or Kathleen McGuire to discuss the situation.
Q: My spouse has dental coverage. What rules must be followed that decide the order in which the plans will pay benefits?
A: The "Birthday Rule" applies. Please see your Dental Booklet for more information or contact The Preferred Group (ask for Melanie Hiller).
Q: How are coordination of benefits for dental handled when two employees are married?
A: For in-network claims: If both parents work for Nanuet and dependents (including spouse) are covered under both, the primary pays first until the individual annual max is reached and any remainder of what the fee schedule would pay is paid by the secondary. Preferred’s payment is not up to the full charge from the dentist but up to what the max the fee schedule would pay. A co-pay would still apply.
For out-of-network claims: If both parents work for Nanuet and dependents(including spouse) are covered under both, Preferred’s payment would work as a normal coordination of benefits. This means the payment would cover up to the max under both plans, but not to exceed the full amount charged.
Q: My dentist would like to become a participating provider? What can I do?
A: Please contact Melanie Hiller at The Preferred Group.
Q: Are domestic partners covered?
A: Yes
Q: My benefit plan did not cover the full cost of medical, dental work, etc. Why is this?
A: The provider billing may have been excessive and was beyond customary and reasonable.
Q: Why was my dental claim rejected or a minimal amount paid?
A: Have your claim reviewed by a trustee or come to a monthly trust meeting to have your claim reviewed by the trustees.
Q: I have met my maximum yearly amount with a participating provider and I am still in need of services. What happens now?
A: In most cases, the participating provider will continue to charge you the reduced rate that they normally accept as payment in full for charges above the yearly maximum. This is done as a courtesy to patients and is not part of the agreement to be a participating provider. Providers are free to charge you their normal rate for services beyond the yearly maximum. If this does happen, however, please be sure to make one of the mangers aware.
Q: How long do I have before I file a dental claim?
A: The dental plan year runs from 1/1 through 12/31. Claims for the previous year can be submitted to Preferred Group up to 90 days after the end of the previous plan year.
Excess Major Medical Supplemental Plan
Q: If I drop my NYSHIP/Empire Plan coverage and use my spouse's medical insurance, can I continue with my Excess Major Medical Insurance through Preferred Group Plans?
A: You may continue with the Excess Major Medical plan coverage provided that the medical coverage you will be covered under is also NYSHIP The Empire Plan.
Q: Can I have single NYSHIP/Empire coverage and still be enrolled with excess major medical as family coverage?
A: In most cases, the answer is no. However, if your spouse has single NYSHIP/Empire coverage and you have single NYSHIP/Empire coverage, you may hold a family excess major medical coverage.
Q: I (or an eligible dependent) used a medical service that was not covered under the NYSHIP/Empire Plan. How do I get reimbursed through my excess major medical plan?
A: If you incur out-of-network expenses, out-of-network expenses are covered on a dollar-for-dollar basis up to the $1000 NYSHIP/Empire Plan deductible (customary and reasonable rates). As of 2019, the deductible is $1250, but we will only reimburse up to $1000. Forward your statements, NYSHIP EOB and the Excess Major Medical claim form (see Benefit Forms page) to Preferred Group Plans. This may be done yearly or at the time of service. All claims must be filed by March 31st following the end of the plan year. You CANNOT be reimbursed for co-pays.
Once you reach the $1250 deductible, NYSHIP will cover 80% of the customary and reasonable rates for out-of-network expenses. The 20% remaining is known as the co-insurance and the member is responsible for this. Fortunately, the excess major medical plan (administered by Preferred Group Plans) will reimburse you for the 20% co-insurance (C&R rates). Once a member incurs $3750 in out-of-network expenses, NYSHIP will reimburse at 100% of C&R rates.
The member may still owe money to the provider if they are being charged rates above customary and reasonable.
Q: I just spent time in the hospital. How do I get my $50 benefit for each night I spent in the hospital?
A: Please see the "Forms" page. Download, print and complete the form. Please note: This benefit is for the employee or retired employee only - NOT spouses or dependents. There is a maximum benefit of $1500 (or 30 days) per year. You must carry the excess major medical plan in order to have this benefit.
Q: Can changes be made to my Excess Major Medical policy?
A: Only if there is a family status change or during the open enrollment period in September (those changes, however, will need to be made prior to that during the summer).
Vision: Davis Vision
Q: I am eligible for two pair of eyeglasses. What is the calendar year for both plans?
A: Davis Vision, administered by Preferred Group Plans:
Basic Davis Vision: 1 year from date of last eye exam; 1 year from date you last received glasses / set of contacts
Enhanced Davis Vision: 1 year from date of last eye exam; 6 months from date you last received glasses / set of contacts
Q: My glasses broke. Is there any kind of a warranty?
A: As long as the glasses were purchased from a participating provider, there is a one-year guarantee.
Q: We retired out of the metropolitan area and need eyeglasses. Are there any participating providers in Florida or other states?
A: Participating providers may be found at the Davis Vision website.
Q: Is it possible to have two vision exams per year?
A: The Basic Davis Vision Plan and the Enhanced Davis Vision plan offer one eye exam annually with an optometrist. You may be able to schedule a visit with an ophthalmologist through your medical coverage.
Life Insurance
Q: Can my policy be continued upon retirement or a leave of absence?
A: Yes at a our group rate. You will be billed directly by JJ Stanis (the broker for our life insurance policy). Eligible retirees of the District are able to continue life insurance coverage in retirement.
Q: Can my beneficiaries be changed?
A: Yes, see a trustee to fill out the appropriate paperwork.
Q: Can my life insurance amounts be changed at any time?
A: No. It may only be changed if there is a change in family status or during the open enrollment period in September.
Retirement
Q: What benefits, outside of District health insurance, continue in retirement?
A: Presently dental, vision, excess major medical and Health Advocate (you receive Health Advocate at no additional cost) will be billed to an eligible retiree directly by the Preferred Group. If you retiree on June 30th, you will owe 6 months of premiums to cover you from July 1 – December 31. If you retire on a different date, the premium owed will be different. In retirement, the plan year for your benefits is the calendar year.
SRP Clerical and teaching assistants (hired before July 1, 2005) will have their vision plan paid for by the district in retirement.
Life insurance will be billed by J.J.Stanis and may be converted to a whole life policy.
NOTE: Eligible retirees have the option to continue with any combination of coverages; however, if you decide to drop one of the benefits, you cannot restart the benefit coverage the following year. An optional bill will come in July from Preferred Group (JJ Stanis will bill separately) for the next coverage year. All, half or none of the optional bill can be paid. A final bill for the next coverage year will arrive in November. Any balance left on that bill will be due by December 31st. No claims can be processed until all premiums are paid in full. FAILURE TO PAY PREMIUMS WILL RESULT IN A LOSS OF COVERAGE.
Q: How much does dental, vision and excess major medical cost in retirement?
A: Please contact an NTA Benefit Fund trustee.
Q: How are dental, vision and excess major medical benefits paid for in retirement?
A: Eligible retirees will be billed by Preferred Group twice for the following calendar year. In the summer before the new plan year (plan year starts on January 1), eligible retirees may opt to pay the full premium, half the premium or none at all. In November, a second billing will come from Preferred Group and the remaining balance plus any increases will be due by before January 1.
Q: Can I pay half a year at a time? Preferred Group Plans said that I am able to.
A: NO. The only time you will pay for a portion of a year is when you retire. For example, if you retire 6/30, you will pay half a year of premiums to extend your coverage through 12/31. Going forward, you will receive two bills each year (July/August bill and November/December bill). By 12/31 all premiums must be paid in full for the next plan year. Often, Preferred Group gives out incorrect information about our policies. Any issues, please contact the NTA Benefit Fund managers.
Q: What is an "eligible retiree"?
A: Please click here
Q: What rules govern benefits (dental, vision, excess major medical) during retirement?
A: Please click here
Q: What are the rules regarding a surviving spouse's benefits coverage if the former employee dies?
A: Please click here
Q: Can AFLAC be continued in retirement?
A: Yes at the current group rate, it will no longer be paid using pre-taxed dollars since you will not be on the district payroll. Instead, AFLAC will bill you directly.
Q: I retired prior to 1994. Are there any dental benefits available to me?
A: No, but try NYSUT's Dental Plan.
Q: We are retired and had been enrolled in the dental plan a few years ago. Can we re-enroll?
A: No. Once you leave the dental plan (while in retirement), you can NOT re-enroll.
Q: How does the new teacher contract starting on July 1, 2022 impact what I pay for health insurance during retirement?
A: Please click here. This file has both its own FAQ and necessary forms. This new provision only pertains to active employees covered by the contract starting on July 1, 2022.