Retired Members
Letter From Chairman
Dear Retiree:
As Chairperson of the Security Benefits Fund, I am pleased to provide you with this booklet containing important information on the benefits negotiated by your Union and provided through the retiree benefit fund.
It is our goal to have all our retirees familiar with all the benefits that are provided through the Retiree Benefits Fund. Please read this booklet carefully and keep it in a convenient place for handy reference in the event that you need to take advantage of its benefits.
In addition, should you have any questions concerning the plan or require assistance, please do not hesitate to contact the Fund Office at (212) 941-5700.
I wish you success and good health in the coming months and years.
Fraternally,
Imogene V. Jones
Outline of Benefits
All claims for the calendar year must be received by January 31st of the next calendar year.
Co Pay – See Claim Form
Dental Benefits – This benefit provides coverage for general dentistry, prosthetics and orthodontia.
Optical Benefits – This benefit provides an eye examination and one pair of glasses for each Retiree, spouse and dependent children every year.
Supplementary Maternity Benefit – The Fund will reimburse the retiree $1000.00, over and above any insurance benefit received in maternity cases.
Adoption Benefit – The Fund will reimburse a retiree up to $1000.00 towards the cost of a legal adoption.
Annual Physical ExaminationThe Annual Physical Examination is provided by Manhattan Internal Medicine Associates, P.C. The member and spouse are covered at no cost. No voucher is necessary, just call and make the appointment. Visit the link section for contact information.
Supplemental Hospital-Medical Benefit – The Fund will make a reimbursement of $100 per day to any Retiree or spouse who is confined in a hospital up to a total maximum reimbursement of $1,000 per year. The supplemental Hospital-Medical benefit is not payable for Maternity Cases.
Hearing Aid – The Fund will provide a hearing aid for retiree and spouse. The benefit is payable once every four years and will be for $400 for each ear to cover the cost for an examination and appliance. This benefit will be offset by any reimbursement from any insurance plan. A claim form is necessary and is available from Cook Associates.
General Information (Eligibility)
Dental Benefit
The New York State Court Clerks Security Benefits Fund provides a full range of Dental Benefits.
There are currently three dental plan options:
1. Self-Insured Plan (Reimbursement), with a participating provider option.
2. Dentcare Plan (HealthPlex)
Who is eligible?
Retirees and their eligible dependents, as defined on pages 2-3 of the section entitled “General Information” are covered. However, only eligible dependent children up to their 19th birthday arecovered for orthodontic benefits.
Click Below for details on each plan.
Vision Benefit
Who is covered?
Members and eligible dependents, (children to age 19 or up to age 25 if they are full-time students).
Benefits
The Fund offers many options: Vision Screening, General Vision Services (GVS), Vision Care Centers, and Raymond Opticians for all retired members and their eligible dependents.
GVS now includes General Vision, Select Cohen’s Fashion Optical and Vision World Stores, S H Laufer, Sterling Optical, Eye Supply, Lens Lab Express, and many popular optical outlets making them the largest 3rd party optical company in our area.
An optical voucher is required and must be obtained from the union office before visiting any of these network providers.
if you wish to go to any store in the GVS Provider Network, Vision Screening, Vision Care Centers, or Raymond Opticians. Please call one of the listed optical locations in the brochures for an appointment.
For member locations in Florida, Connecticut, New Jersey, and Upstate New York, please call 1-800-VISION or visit www.generalvision.com or visionscreeninginc.com.
Any member or eligible dependent may visit any other optical provider not in the above networks and that member will be reimbursed up to $300 upon the submission of an Optical Reimbursement Form and an itemized receipt. Credit card receipts will not be accepted.
Also note that if any member is to schedule an eye exam with GVS and any GVS employee requests our member to submit the Empire Plan health insurance card, the member shall not submit the card unless an explanation is given, what will be done with the information and if a claim will be submitted to United Health Empire Plan. Remember, comprehensive eye exam is covered under our plan with GVS.
To Review:
A Voucher is required if you wish to go to any store in the GVS Provider Network, Vision Screening, Vision Care Centers, or Raymond Opticians.
Please note that any member or eligible dependent may visit any other optical provider not in the above networks and that member will be reimbursed a maximum of $300.00 upon submission of an Optical Reimbursement Form and an itemized receipt. Credit card receipts will not be accepted.
Vision Care Centers
Voucher Required
View benefit pamphlet with locations
General Vision Benefits
Voucher Required
1-800-vision1
www.generalvision.com
View Benefit Flyer
Additional $50 Coupon
Vision Screenings
Vision Screening Locations
Voucher Required
1-800-652-0063
Click here to find closest provider
Additional $50 Coupon
Raymond Opticians
Raymond Opticians
Voucher Required
Visit Store website for all store locations and directions.
Adoption Benefit
Amendment or Termination of Benefits
Your coverage and your dependent’s coverage will stop on the earliest of the following dates:
- When the Fund is terminated
- When you are no longer eligible
- When there is a non-payment of the direct payments
- When the State of New York or the quasi-public Agency, Authority, Board or Corporation ceases to make contributions on your behalf to the Fund
- Your dependents’ coverage will also terminate when they are no longer your eligible dependents.
Active member benefits under this plan have been made available by the Trustees and are always subject to modification or termination in the exercise of the prudent discretion of the Trustees. No person acquires a vested right to such benefits either before or after his or her retirement. The Trustees may expand, modify or cancel the benefits for active members; change eligibility requirements or the amount of the direct payments; and otherwise exercise their prudent discretion at any time without legal right or recourse by a member or any other person.
Annual Physical Examination
The Annual Physical Examination is provided by Manhattan Internal Medicine Associates, P.C. The member and spouse are covered at no cost. No voucher is necessary, just call and make the appointment. Visit the link section for contact information. Your Health Care ID is necessary, the association covers the co-payment.
Manhattan Internal Medicine Associates, P.C.
145 East 32nd Street, Suite 303
New York, NY 10016
212-725-5300
https://www.manhattanmedicine.net/
Appeal Procedure
Coordination of Benefits
What is Coordination of Benefits?
When benefits would be payable under more than one group plan, benefit payments will be coordinated so that the total benefits paid under all group plans will not exceed 100% of the total amount charged. If you and your spouse are both members of the New York State Court Clerks Security Benefits Fund and eligible for benefits, your benefit payments will also be coordinated not to exceed 100% of the total amount charged.
How does Coordination of Benefits work?
If you are a covered member of the Fund and are eligible for benefits from another group plan:
- Submit your claim to the Fund office.
- After you have received payment from the Fund, you may submit a claim for the unpaid balance to the other group plan under which you are eligible for benefits.
- You will receive any additional benefits, which may be due for this claim under the second plan.
- The total amount you receive for the claim from this Fund and from any other group plan cannot exceed 100% of the total amount charged.
If your spouse has a claim and is eligible for benefits under another group plan:
- Your spouse must submit a claim to his or her plan first.
- After the claim is paid by your spouse’s plan, a claim for the unpaid balance may be submitted to this Fund along with an explanation of benefits received from the other plan.
- Any additional benefits, which may be due for this claim, will be paid by this Fund.
- The total amount paid for the claim from any group plan under which your spouse is eligible and from this Fund cannot exceed 100% of the total amount charged.
If a claim is submitted for a child when one parent is a covered member of the Fund and the other parent is a covered member of another plan:
- Submit this claim to the plan of the parent whose birthday (month and day only) occurs first in the calendar year.
- After the claim has been paid by the first plan, it may be submitted to the second plan along with an explanation of benefits received from the first plan.
- The payment you receive for the claim from both plans cannot exceed 100% of the total amount charged.
If the claim is submitted for a child whose parents are divorced when one parent is a covered member of the Fund and the other parent is a covered member of another plan:
If the parent with custody has not remarried,
- Submit the claim to the plan which covers the parent with custody first.
- After the claim has been paid by the first plan then it may be submitted to the second plan along with an explanation of benefits from the first plan.
If the parent with custody has remarried,
- Submit the claim to the plan which covers the parent with custody first.
- Submit the claim to the plan which covers the step-parent second.
- Submit the claim to the plan covers the parent without custody last.
If there is a court order which establishes financial responsibility for the medical, dental or other health care expenses of the child, submit the claim to the plan which covers the parent with the court ordered responsibility first. A copy of such court order must be submitted with your claim.
Hearing Aid Benefit
HeartScan Services
The Heartscan Services screening benefit is free and available to active and retired members and their spouses. Heartscan Services provides five preventive screens that focus on early detection for Heart disease (echocardiogram-), stroke (carotid doppler), thyroid cancer (nodules), vascular disease (ABI) and abdominal aortic aneurysm (AAA). The preventive screening takes about 45 minutes, is non-invasive and is available to our active and retired members and spouses every year.
For more information visit: www.heartscanservices.com
Call 1-866-518-1112 to schedule your appointment
Hospital Benefit
When a retiree or spouse is confined in a hospital, the Fund will provide an allowance of $100 per day up to a maximum of $1000 per year. This amount is in addition to any allowance provided by Blue Cross.
The Fund will reimburse on a per stay basis. The maximum allowable benefit is $1000 per year. To file a claim for this Supplemental Hospital-Medical Benefit the member should submit to Cook Associates, a copy of the hospital bill which will reflect the name of the patient and the period of confinement. It is not required that the bill reflect the reason for confinement. All claims for the calendar year must be received by January 31st of the next calendar year.
Exclusions
The day of discharge is not covered by this benefit.
Inner Imaging Full Body Scan
The Trustees of the Security Benefit Fund have reached an agreement with Inner Imaging and the radiology group New York Medical Imaging Associates. Members and Spouses may choose to receive the (EBT Body Scan) through Inner Imaging and the radiology group New York Medical Imaging Associates located at 165 East 84th Street (Between Lexington and Third avenues).
Office hours are Monday thru Friday 7:30AM to 4:30PM and Saturdays from 8:00AM to 2:00PM. Telephone 212-777-8900 (Fax 212-991-5450). The exam cost for Member and/or Spouse will be covered for the Heart, Lung scan and also for the Heart, Lung, Abdomen, and Pelvis screening. The balance will be paid by the Court Clerk Benefit Fund. Non-Union members have paid upwards of $800 – $1,200 for this procedure.
This benefit will be provided once every five years and will count toward your eligibility for the Manhattan Internal Medicine Associates, P.C. services for the year that it is utilized.
Maternity/Paternity Benefit
The Fund will reimburse a covered member in the amount of *$1,000 per live birth. To apply for this benefit, a copy of the birth certificate and a Change in Benefit Status Form adding the child as a dependent must be filed with the fund office.
Third-Party Reimbursement/Subrogation
Fund benefits will be provided only on the condition that the covered member or dependent agrees in writing:
- To reimburse the Fund, to the extent of benefits paid by it, out of any money recovered from such third party, whether by judgment, settlement or otherwise;
- To provide the Fund with an assignment of proceeds to the extent of benefits paid out by the Fund on the claim and to cooperate and assist the fund on seeking recovery. The Assignment will be filed with the person whose act caused the injuries, his or her agent, the court and/or the provider of services;
- To take all reasonable steps to affect recovery from the responsible third party and to do nothing after the injury to prejudice the Fund’s right to reimbursement or subrogation, and to execute and deliver to the Fund Office all necessary documents as the Fund may require to facilitate enforcement of the Fund’s rights and not to prejudice such rights.
Additional Information
The Collective Bargaining Agreement requires contributions to the Fund at fixed rates per year worked. Benefits are provided from the Fund’s asset which are accumulated under the provisions of the Collective Bargaining Agreement and the Trust Agreement and held in a Trust Fund for the purpose of providing benefits to covered participants and defraying reasonable administrative expenses. Some of the benefits are provided through insurance policies.
All the types of benefits provided by the Fund are set forth in the Outline of Benefits of this booklet. The complete terms of the insured benefits are set forth in the group insurance policies or contracts with the organizations. The complete terms of the self-insured benefits are set forth in the Fund Rules and Regulations.
As someone who is eligible for benefits from this Fund you are no doubt aware of the fact that the benefits are paid in accordance with plan provisions out of a trust fund which is used solely for that purpose. If you have any questions or problems as to benefit payments, you have the right to get answers from the Trustees who administer the Fund. Nothing in this statement is meant to interpret or extend or change in any way, the provisions expressed in the Fund or insurance policies. The Trustees reserve the right to amend, modify or discontinue all or part of the Fund whenever, in their judgment, conditions are warrant.