Who Is Eligible?
Covered member, spouse or registered domestic partner and dependent children to age 19, Full-time college students to age 23, Physically impaired dependents, Registered Domestic Partners ("RDP").
1. Life Insurance
MEMBER:$ 25,000 up to age 65 (Eff. 1/1/97)
$ 5,000 ages 65 through 69
$ 1,000 ages 70 and over (Self Insured)
Life insurance will be half of above from 4th to 12th month – full coverage after one year of employment.
Within 45 days of termination of active status, life insurance may be converted to an individual policy without medical questions asked.
2. Dental Program
ASO/SIDSMaximum of $ 2,500 for each individual covered by the plan (Self Insured through Fund) per calendar year for other than orthodontics.
Lifetime maximum benefit for orthodontic treatment is $ 2,500. Limited to eligible dependent children and for non-cosmetic adult procedures.
Each individual covered under the plan is subject to a $50.00 deductible, with a $100 maximum family deductible per calendar year.
Dental plan is administered through Self-Insured Dental Services (SIDS) based on a schedule of payments.
In addition to the scheduled plan, arrangements have been made for scheduled plan to be accepted as payment-in-full by any of the participating dentists listed on the panel. Contact Plan Administrator for listing.
3. Prescription Drug Plan
Because of recent changes to this plan you must call Alicare directly at 212-539-5117.
4. Newborn Benefit
Effective 5/1/98, up to $500.00 benefit to cover expenses for birth of child or adoption of a child who is up to 18 years of age.
5. Hearing Aid
$600.00 per device per eligible family member of full time member once every three years.
6. Long Term Disability
Eligible Member must work 30 hours or more per weekBasic coverages are:
A. 50% of salary up to a maximum of $ 3,000 monthly to age 65.
B. Waiting Period: 90 days. All sick time must be deducted if a member's sick time exceeds 90 days. For example, if member has accrued 100 days of sick leave, insurance plan will not pay from 90th day to the 100th day. Benefits commence on 101st day.
C. Maternity would be covered if employee became disabled as a result of pregnancy complications or other illness.
D. Claim must be submitted within 6 months of onset of disability.
7. Short Term Disability
Eligible member must work 35 hours or more per week.
Weekly benefit: $300.00 per week
Elimination Period: 14 days of continuos disability or end of accumulated sick pay, whichever is longer. (MEMBER ONLY BENEFIT)
8. Optical Benefit
Provides an eye examination and/or one pair (Self Insured through Fund) of eyeglasses/contact lenses for member and eligible dependent once per calender year.Max one benefit per person per year.
**Choice of using participating plan or own optometrist.
If using non-participating, reimbursement will be as follows:
Up to $100.00 Glasses and/or examination
Up to $100.00 Contact Lenses with or without exam
Video Display Benefit
If necessary, member may be eligible for additional exam/glasses once every 24 months through NYC. Member only benefit. Must meet eligibility requirements and Comprehensive Optical or Vision Screening special VDT provider must be used.
Plan Administrators
Alicare730 Broadway
New York, NY 10003
Telephone: 212-539-5117
Email: CSBAinfo@Alicare.com
