Printable Claim Forms
Fee Schedules
Open Enrollment
September is Open Enrollment Month for members to add eligible spouses and dependents to the Welfare Fund’s Supplemental Dental Coverage
Enrollment for September of 2020 begins Sept 1st and ends on Sept 28th. All forms and documentation must be received by this date.
- Supplemental Coverage Enrollment Form
- Enrollment Documentation Requirements
- Important Information for Dependent Coverage
- Domestic Partner Letter
- DENTAL OPEN ENROLLMENT 2020-2021
Benefit and Program Information
Summary Plan Description (SPD)
BENEFITS AT A GLANCE
Statement of Grandfathered Status
UNUM Life Insurance
Stacey Braun Financial Counseling Program
HIPPA
** EAP Program This program is being provided by the district
*** A CHANGE IN TELEMEDICINE:
It has come to the attention of the Trustees that The Empire Plan now covers telehealth visits with participating providers in the Medical/Surgical Program and the Mental Health and Substance Abuse (MHSA) Program. Telehealth visits with a doctor or therapist are subject to the same copayment as in-person visits. Currently, copayments for telehealth visits with participating providers are waived under the NYS Department of Financial Services emergency COVID-19 regulation.*
Note: Deductible and coinsurance apply for telehealth visits with nonparticipating providers, except where federal regulations require a cost-share waiver for diagnosing COVID-19. Additionally, Medicare also provides enrollees with a Telemedicine option.
Therefore, the Trustees have voted NOT TO RENEW the Telemedicine benefit with 800MD. This benefit will end on June 30, 2021. Please contact your health care insurance for questions regarding enrollment in their TeleHealth program.