Benefits

The following are eligible participants in the Plan:

1. A Full-Time Employee covered by the collective bargaining agreement between the SCCEA and the State of New York-Unified Court System who is in Full Pay Status and whose normal work schedule consists of at least 70 hours per bi-weekly pay period (hereinafter referred to as “Full-Time Employee”). A Full-Time Employee who is on authorized leave pursuant to the Family and Medical Leave Act, and a Full-Time Employee who is absent on Workers’ Compensation Leave for whom the Fund is receiving contributions shall be entitled to a continuation of benefits while on such leave. A Full-Time Employee receiving Sick Leave at half pay that is not on authorized leave pursuant to the Family and Medical Leave Act shall be considered an eligible Part-Time Employee.

2. A Part-Time Employee covered by the collective bargaining agreement between the SCCEA and the State of New York-Unified Court System who is in Full-Pay Status and whose normal work schedule consists of at least 35 hours per bi-weekly period (hereinafter referred to as “Part-Time Employee”). Eligible Part-Time Employees are eligible for Dental Benefits only. A Part-Time Employee who is on authorized leave pursuant to the Family and Medical Leave Act, and an employee who is absent on Workers’ Compensation Leave for whom the Fund is receiving contributions, shall be entitled to a continuation of benefits while on such leave.

3. A Dependent of an eligible employee (hereinafter referred to as “Dependent”) who is one of the following:

a. The Spouse of an eligible employee, provided he or she is not legally separated from the employee (hereinafter referred to as “Spouse”)

b. The Child of an eligible employee, ending the month in which the child turns age 26.

c. A Domestic Partner of an eligible employee. To qualify, the Domestic Partnership must be registered in the office of the county clerk in any county in New York State or in any similar registry in another state.

d. An unmarried child or grandchild of an eligible employee who permanently lives with the eligible employee and is supported by hi, or her pursuant to a court order awarding legal guardianship, provided that guardianship commenced before the child attained the age 26.

e. An unmarried child of an eligible employee who is incapable of self-support, regardless of age, by reason of mental or physical disability and who became so disabled before reaching the age of 26.

f. Coverage may be extended past the age of 26 for an unmarried child who is a full-time student, had four (4) years of service in a branch of the U.S. Military between the ages of 19 and 25 and is not eligible for other employer group health coverage. Up to four (4) years of military service may be deducted for the child’s age until the adjusted eligibility age equals 26.

4. All employees must provide the Fund with their current address

**Please refer to your SCCEA Welfare Fund Booklet for full explanation of benefits

Employees

1. Except as provided in paragraph 2 below, eligibility for employees commences upon completion of 60 consecutive days of full-time service in a position within the SCCEA bargaining unit, provided necessary enrollment cards are completed and filed at the Fund Office. Dependents become eligible at the same time the employee does. However, if the required enrollment card is not submitted by the time an employee completes 60 consecutive days of full-time service, eligibility for eligible employees and dependents will commence on the 1st day of the month following receipt of the enrollment card.
2. Eligibility for (a) employees who transfer or promote into the SCCEA bargaining unit from other collective bargaining units in the Unified Court System and (b) previously unrepresented employees of the Unified Court System assigned to Suffolk County who are placed in the SCCEA bargaining unit shall commence upon the 1st day of assignment within the SCCEA bargaining unit, provided necessary enrollment cards are completed and filed at the Fund Office.
   
   If the required enrollment card is not submitted on or before the 1st day, eligibility shall commence, on the day the enrollment card is received. 
3. No benefits shall be payable for any services performed prior to the date the employee becomes an eligible participant in the SCCEA Welfare Fund.

**Please refer to your SCCEA Welfare Fund Booklet for full explanation of benefits

Non-Orthodontic‍

Payment will be made for each Dental Service up to the amount provided under the Schedule of Covered Dental Expenses. This Schedule is contained in a separate pamphlet. There is a $2,500.00 annual per person maximum for Non-Orthodontic services in a calendar year. In the case of Pediatric Dentistry, treatments shall be paid pre schedule.‍

Orthodontic

The maximum lifetime separate benefit available is $1,995.00. Pediatric Orthodontic treatments shall be paid pre schedule.

**Please refer to your SCCEA Welfare Fund Booklet for full explanation of benefits

PREMIUM/CONTRIBUTIONREIMBURSEMENT PLAN
(effective January 1,2024) or
HEALTH EXPENSE REIMBURSEMENT BENEFIT

**you can select either (but not both)

• The Benefit shall be $300.00 per     calendar year for Full-Time Employees
• The Benefit shall be $100.00 per     calendar year for Part-Time Employees
• The Benefit shall be $200.00     per calendar year for Retired Employees
  ‍
• Who is Eligible:
• Full-Time Employees
• Part-Time Employees
• Retired Employees

PREMIUM/CONTRIBUTION REIMBURSEMENT BENEFIT

Premium contributions toward NYSHIP or anyother New York State issued Health Plan applicable to Court Employees, such asemployee co-payments, up to $300.00 per calendar year for Full-TimeEmployees, $100 for Part-Time Employees and $200 for Retired Employees. Paymentis limited to such premium contribution required to be made by an employee. Toreceive reimbursement of a premium contribution, you will need to provide theFund Office with supporting documentation such as a record of your salarypayment. (i.e., a copy of your most recent pay stub indicating a year-to-datepayment of the Health Insurance Premium totaling at least $300 for Full-TimeEmployees, $100 for Part-Time Employees and $200 for Retired Employees)

Reimbursement of Claims

Claims can be submitted at any time until themaximum is met, but not later than the last business day of the year inwhich reimbursement of the premium contribution is sought.

HEALTH EXPENSE REIMBURSEMENT BENEFIT (ALTERNATE)

The Health Expense ReimbursementBenefit can be used for reimbursement of prescription drug benefits,and Health Insurance Copayments. The benefit shall be $300.00 per calendaryear, effective January 2024 for Full-Time Employees, $100 for Part-TimeEmployees and $200 for Retired Employees. All prescription drugs and healthinsurance copayment claims shall be processed as part of this benefit.

Reimbursement of Claims

To receive reimbursement from eligibleexpenses you incur on or after January 1st - December 31^st of the calendaryear, you will need to complete a claim form and send it to the Fund Officealong with all supporting original documentation (Explanation of Benefits (EOB)or other proof of your eligible health care or prescription expenses) that willverify the claim.
No reimbursement will be made without, at minimum, (1) a writtenstatement of an independent 3rd party such as an EOB for you stating that theexpense had been incurred and the amount of the expense and (2) awritten statement and documentation (e.g., pharmacy receipts or print outs fromthe participant that the expense has not been reimbursed and is notreimbursable under another health plan coverage.
No reimbursement of eligible health care expenses under this benefitprovision shall be made if such expenses have been reimbursed by any otherhealth care insurance, provider or entity or if you have filed a claim for apremium/contribution reimbursement claim during the calendar year.
Claims can be submitted only ONCE A YEAR at any time after the maximumexpense amount ($300 for Full-Time Employees, $100for Part-Time Employees and $200 for Retired Employees) but in no eventlater than the last business day of that calendar year in which the claim wasincurred.

The Fund will pay one (1) claim up to $525.00 towards the cost of a hearing aid for each person eligible for this benefit once every four (4) calendar years commencing with the year of service. Covered expenses are limited to charges for the cost and installation of a hearing aid as prescribes by an Otologist, Audiologist or Physician. The Fund will provide a $75.00 benefit for the repair of a hearing aid once every four (4) years. The benefits are non-cumulative.

Exclusions

1. Expenses for which benefits are payable under Workers’ Compensation Law.
2. Expenses for which benefits are payable under Medicare or other Government plan.
3. Special Procedure training, such as lipreading courses, schooling or institutional services.
4. Medical or surgical treatment of the ear or ears.
   

**Please refer to your SCCEA Welfare Fund Booklet for full explanation of benefits

Who Is Eligible

Full-Time and Part-Time Employees and eligible dependents. Benefits commence in the 1st day of the month following completion of 60 days full time service EXCEPT if the required enrollment card is not filed, in which case eligibility will commence on the 1st day of the month following the month in which the enrollment card is received at the Fund Office.

Coverage for any person who thereafter becomes an eligible dependent shall commence on the 1st day of the month following the date upon which an enrollment card for such dependent is received.

Benefit Defined

The Fund will provide a Life Insurance Policy for eligible Full-Time Employees and their dependents according to the schedule outlined in the insurance certificate. Full details of all provisions are contained in the certificate issued by the insurance carrier, Full-Time Employee Coverage is $50,000 with an additional payment of $50,000 for accidental death and dismemberment. Part-Time Employees is $25,000 with an additional payment of $25,000 for accidental death and dismemberment. Spousal and dependent coverage is $10,000 for Full-Time Employees and $5,000 for spousal and dependent coverage for Part-Time Employees. A Dependent is covered up to 18 years of age, unless a full-time student where limit is age 23.

Filing Requirements

The Beneficiary must give written notice of claim and proof of life insurance per the terms of the insurance policy with the Welfare Fund.

Limitations

A person may not have coverage both as an eligible employee and as a covered dependent. If both spouses are Full-Time Employees only one (1) eligible spouse may cover the eligible children as insured dependents.

The Fund will reimburse up to $150.00 in any calendar year for each eligible participant for optical services obtained from any licensed optometrist, ophthalmologist or optician. Reimbursement for all claims shall be based on a one-time payment per plan participant.

Filing Requirements

Claims must be submitted NO LATER THAN December 31st of the calendar year in which the claim was incurred

**Please refer to your SCCEA Welfare Fund Booklet for full explanation of benefits

Who Is Eligible

• Full-Time Employees between the ages of 40 and 70
• Retirees between the ages of 40 and 70

Benefit Defined (One Time Benefit)

The Fund will provide a maximum reimbursement of $200.00 per lifetime for one Heart, Lung or Body Scan by a provider arranged by the Fund. This benefit shall not apply to scans which are covered by insurance.

Claims must be submitted NO LATER THAN December 31st of the calendar year in which the claim was incurred.

**Please refer to your SCCEA Welfare Fund Booklet for full explanation of benefits

EXCUSED LEAVE FOR CANCER SCREENING INFORMATION

‍

In some circumstances, it may be possible for you and/or your dependents to continue coverage under the Plan when your coverage would have otherwise terminated.

A.  COBRA Continuation Coverage

If your Plan coverage is terminated, you may be entitled to continue your coverage on a self-pay basis in accordance with The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

For individuals covered by the Plan as employees, COBRA continuation coverage may be elected upon loss of coverage under the Plan due to voluntary or involuntary termination or employment (except for gross misconduct) or because the employee no longer meets the eligibility requirements of the Plan due to a reduction in hours of covered employment.

Your spouse may elect and be considered a Qualified Beneficiary for COBRA continuation coverage if he or she loses coverage because of the occurence of any of the following events:

• Your death
• Your spouse’s loss of coverage under the Plan due to voluntary or involuntary termination of your employment (except for gross misconduct) or because you no longer meet the eligibility requirements of the Plan due to a reduction in your hours of covered employment.
• Divorce or legal separation
• You become entitles to Medicare (even if such entitlement occurs while you and/or your spouse is already receiving COBRA continuation coverage)

Your dependent child may elect and be considered a Qualified beneficiary for COBRA continuation coverage upon the occurrence of any of the following events:

• Your death
• Termination of your employment (except gross misconduct) or because you no longer meet the requirements of the Plan due to a reduction in your hours of covered employment
• Divorce or legal separation
• You become entitled to Medicare (even if such entitlement occurs while you and/or your dependent child is already receiving COBRA continuation coverage
• The child ceases to qualify as an “eligible dependent” according to the Plan

Notice Requirements

Under COBRA, you (or your spouse or dependent child, if applicable) must notify the Fund Office within 60 days after:

• You and your spouse are divorced
• One of your children loses their dependent status under the Plan

You (or your spouse or dependent child, if applicable) will then be notified of your right to elect continuation coverage and the cost to do so.

Deadline to elect COBRA

The deadline for electing continuation coverage is 60 days after the date the Fund ceases to cover you from the date you are notified, whichever is later.

If you (or your spouse, or dependent child, if applicable) does not elect continuation coverage, your coverage will stop. If you (or your spouse, or dependent child, if applicable) chooses continuation coverage, the Fund will provide coverage identical to that available to similarly situated active employees, including the opportunity to choose among options available during open enrollment. However, you (or your spouse, or dependent child, if applicable) must pay the full cost of this coverage.

If a covered employee or spouse of a covered employee elects COBRA without specifying whether the election is for self-only coverage, the election will be considered to be on behalf of all other qualifies beneficiaries with respect to that qualifying event

**Please refer to your SCCEA Welfare Booklet for FULL explanation of these benefits

Attached is the SCCEA Welfare Fund Booklet for full explanation of Active benefits

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