Benefits

ENROLLMENT

Coverage for the benefits offered by the Suffolk County Court Employees Association Welfare Fund is not automatic. In order to participate, Eligible Retirees must first enroll themselves and their eligible dependents in the Fund by completing and forwarding enrollment cards to the Fund Office. Enrollment cards can be obtained by calling the Fund Office at (631) 231-3983.

ELIGIBILITY FOR BENFITS

In general, you are eligible to participate in the Fund based upon the criteria below. However, you must refer to each benefit for additional eligibility requirements for that specific benefit.

The following are eligible participants in the Plan:

1. A Retiree for whom the Fund is entitled to receive contributions from the State of New York (hereinafter referred to as “Retiree” or “Eligible Retiree”)
2. A dependent of an Eligible Retiree (hereinafter referred to as “dependent”) who is one of the following:

• The spouse of an eligible retiree, provided he or she is not legally separated from the Retiree (hereinafter referred to as “spouse”)
• The child of an Eligible Retiree, ending the month in which the dependent child turns age 26
• An unmarried stepchild of an Eligible Retiree who permanently lives with the Eligible Retiree and is supported by him or her pursuant to a court order awarding legal guardianship, provided that guardianship commenced before the child attained age 26
• An unmarried child of an Eligible retiree who is incapable of self-support, regardless of age, by reason of mental or physical disability and who became so disabled before reaching age 26.
• A Domestic Partner of an Eligible Retiree. To qualify, the Domestic Partnership must be registered in the office of the county clerk in any county in New York or in any similar registry in another state.
• An unmarried grandchild of an Eligible Retiree who permanently lives with the Retiree and is supported by him or her pursuant to a court order awarding legal guardianship, providing that guardianship commenced before the child attained age 26.
• 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

WHEN ELIGIBILITY BEGINS

1. Eligible individuals who are granted retirement by the NYSERS within thirty (30) days of the last date upon which he or she was in full-pay status be entitled to Fund benefits as a Retiree upon enrollment, with no waiting period so long as contributions are made on their behalf by New York State.

2. All other Retirees (e.g., individuals who vested retirement rights and left service and individuals who were out of pay status for more than thirty (30) days awaiting the granting of an application for disability retirement) become eligible for enrollment on the 1st day of the month following 60 days from the date written notification of the granting of retirement benefits is received by the Fund so long as contributions are being mad on their behalf by New York State.

3. All individuals must provide the Fund with their current address.

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

The Fund will provide a $2,000.00 Death Benefit, self-funded by the Fund, for all the Retirees who file an enrollment card and who are no longer eligible for Life Insurance coverage as an employee. This benefit is subject to income tax.

Filing Requirements

A claimant must provided written proof of loss no later than six (6) months after the date of loss

Non-Orthodontic

Payment will be made for each dental service up to the amount provided under the Schedule of Covered Dental Expenses. There is a $2,500.00 annual per person maximum for non-orthodontic services in a calendar year. In case of treatment of Pediatric Dentistry, treatments shall be paid per schedule.

Orthodontic

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

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

The Fund will pay one 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 prescribed 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

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.

Filing Requirements

• Participating Providers – Claims are submitted by the provider
• Direct Reimbursement – Claims must be submitted no later than 90 Days from the date of service
  

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

If the Eligible Retiree dies or becomes divorced or legally separated or a dependent ceases to be a dependent, the spouse and/or dependent may have rights to continue certain Plan coverage through COBRA. If any of the events set forth above occurs, the Eligible Retiree or dependent MUST inform the Fund of the qualifying event WITHIN 60 Days of the later of the qualifying event and the date on which coverage would be lost because of the event. The rules of COBRA coverage will be provided by the Fund.

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

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