Member Only Benefits
Life Insurance
$ 25,000 up to age 65 (eff. 1/1/97)$ 5,000 ages 65 through 69
$ 1,000 ages 70 and over
Life Insurance will be half of above from 4th to 12th month – full coverage after one year.
Within 45 days of termination of active status, life insurance may be converted to an individual policy without medical questions asked.
Optical Benefit
Provides an eye examination and/or one pair of eyeglasses/contact lenses (Self Insured through Fund) once per calendar year.One benefit per member 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 Terminal Benefit
If necessary, member may be eligible for additional exam/glasses once every 24 months through NYC. Must meet eligibility requirements and Comprehensive Optical or Vision Screening special VDT provider must be used.
Member and Dependent Benefits
Dental Program
ASO/SIDSMaximum of $2,500 for each individual covered by the plan per (Self Insured through Fund) calendar year for other than orthodontics.
Lifetime maximum benefit for orthodontic treatment is $2,500.00. Limited to eligible dependent children and for non-cosmetic adult procedures.
Dental plan is administered through Self-Insured Dental Services (SIDS) based on a schedule.
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.
Plan Administrators
Alicare730 Broadway
New York, NY 10003
Telephone: 212-539-5117
Email: CSBAinfo@Alicare.com
