Frequently Asked Questions...

Insurance Coverage

Q: Who does the NTA Member Benefit Trust cover?

A: Active NTA members, SRP secretarial staff (dental only for active members, dental & vision for retired SRP's), Administrators (dental and vision only) and Retirees (NTA members, SRP's and Admins).

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.

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. The $1 million dollar excess major medical coverage is no longer applicable since there are no life time maximums on medical insurance.


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 the self-funded 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 (that includes the vision care plan through ShelterPoint Life and National Vision Administrators). 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

ShelterPoint Life (Excess Major Medical): January 1-December 31

Davis Vision: 1 year from date of last usage

National Vision Administrators: 1 year from date of last usage

**All bills for NYSHIP/Empire and ShelterPoint Life must be submitted within 3

months of the end of the calendar year (by March 31)


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 and family dental/vision fees are paid through 14 pay periods starting the first pay period in November. Excess major medical and family dental/vision fees are paid using pre-tax dollars.

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 $20 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 $2500 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: 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: How long do I have before I file a dental claim?

A: The dental plan year runs from 1/1-12/31. 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

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 ShelterPoint Life?

A: You may continue with ShelterPoint Life coverage provided that the medical coverage you will be covered under is also NYSHIP/Empire. If you have family NYSHIP/Empire coverage you may opt for either single or family excess major medical coverage. If your spouse's medical insurance is different from NYSHIP/Empire and you still want to have excess major medical through ShelterPoint Life, please follow this procedure:

Here is what you need to do to get approved for coverage:

1. Mail a letter explaining the situation (note that our ShelterPoint Life policy number is XGNY 91194) and a summary/plan booklet of your current medical insurance coverage to:

ShelterPoint Life

600 Northern Blvd.

Great Neck, NY 11021

2. Once you receive ShelterPoint's answer, please contact a trust manager to enroll with ShelterPoint for excess major medical coverage. If you are approved, but then fail to enroll through trust managers, you will not be covered.

Q: Can I have single NYSHIP/Empire coverage and still be enrolled with ShelterPoint Life 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 (United Healthcare). How do I get reimbursed through my excess major medical plan (ShelterPoint)?

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). Forward your statements, NYSHIP EOB and the Excess Major Medical claim form (see Benefit Forms page) to ShelterPoint Life. This may be done yearly or at the time of service. Claims must be filed by March 31st of the following year. You can NOT be reimbursed for co-pays. Please see the plan brochure for more information.

Once you reach the $1000 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 ShelterPoint) will reimburse the member for the 20% co-insurance (C&R rates). Once a member incurs $3000 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 from ShelterPoint Life for each night I spent in the hospital?

A: Please see the "Forms" page. Download, print and complete the form. Make sure you inlcude our policy number (XGNY 91194 for active teachers and teaching assistants, XGNY 1194 for retired teachers, XGNY 1133 for administrators and SRP's). Please note: This benefit is for the primary insured only.

Q: Can changes be made to my ShelterPoint Life 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 and/or National Vision Administrators

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: 1 year from date of last usage

National Vision Administrators, administered by ShelterPoint: 1 year from date of last usage

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 eye glasses. Are there any participating providers in Florida or other states?

A: Participating providers may be found at either the Davis Vision website or the National Vision Administrators website.

Q: Is it possible to have three vision exams per year?

A: Yes, provided you have excess major medical, vision and NYSHIP/Empire coverages.


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).

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 continue upon retirement?

A: Presently dental, vision, excess major medical and Health Advocate (included in billing) will be billed to the new retiree directly by the Preferred Group for July 1-Dec. 31. 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: You have the option to continue with any combination of coverages; however, if you decide to drop one of the benefits, you can not 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 bill needs to 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. FAILURE TO PAY PREMIUMS WILL RESULT IN A LOSS OF COVERAGE.

Q: How are dental, vision and excess major medical benefits paid for in retirement?

A: Starting with July of 2010, retirees will be billed by Preferred Group for the following calendar year. Retirees may opt to pay a portion of their bill at this time (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 December 31st.

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.

Health Advocate

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