Suffolk County Municipal Employees · to make plan payments by check or credit card. Subsequent credit card payments can be made by calling the Fund or on-line through the Fund’s

2015, Volume 42, Issue 4

DECEMBER 2015-Holiday Issue

Suffolk County

Municipal Employees

Benefit Fund Notes

Notary Services are available at the Fund.

Benefit Fund Office is conveniently located in Suite D at the AME Union building, 30 Orville Dr. Bohemia, NY 11716-2513.

Inside this Issue:

Administrator’s Report 2

How to File an Appeal & HIPAA Notice

2

Prescription Co-Pay Reimbursement 2015

3

Optical Voucher Reminder 2015

4

Welcome New Trustees 5

Open Enrollment Reminder 2016

6

PPACA Notice 7-9

Enrollment Require-ments and College Verification

10

Important Phone Numbers & Websites

11

Trustees & Administration

12

The SCME Benefit Fund is a legal entity, separate from Suffolk County Government

and Municipal Unions, administered through a joint Labor/Management Trust.

SUFFOLK COUNTY MUNICIPAL EMPLOYEES BENEFIT FUND

30 Orville Dr. Suite D Bohemia, NY 11716-2513

631-319-4099

CHECKOUT the FUND’S WEBSITE

FOR UPDATES, ENROLLMENT INFORMATION AND CREDIT CARD PAYMENTS AT:

WWW.SCMEBF.ORG

A Joint Labor/

Management

Trust Providing supple-

mental health and

legal benefits for our

participants and their

families since

1975

December 2015 Page 1


ADMINISTRATOR’S REPORT APPEAL AND HIPAA NOTICE

Administrator’s Report - December 2015

We hope you had a very Happy Thanksgiving and are planning for a wonderful Christmas, Hanukah, and Kwanza Holiday season.

This is our final quarter or the “end-of-the-year reminders” issue. It includes notices for Prescription Co-Pay Reimbursement on page 3, for Optical Benefits on page 4, for Open Enrollment on page 6, and for up-dating Enrollment information on page 10.

The Fund’s Annual Open Enrollment is underway allowing Retirees to join one of the “Self-Pay” Enhanced Retiree Plans. Since 2007, the Fund responded to the membership’s request to allow you and your family to enjoy dental benefits and more, at the Active Level of coverage, up to plan guidelines and maximums.

Also included on pages 7-9, is information about the new requirements under the ACA, the Affordable Care Act. Please read this tax important information.

Please let us know if there is anyway we can serve you better by calling me directly at (631) 319-4099, ext. 319. Please accept our best wishes for a very Happy and Healthy New Year!

Cheryl A. Felice Fund Administrator

Availability of HIPAA Notice of Privacy Practices (as of 9/23/13)

The Suffolk County Municipal Employees Benefit Fund adheres to the HIPAA Notice of Privacy Practices ("Privacy Notice"), de-

scribing how health information of individuals covered by the Fund may be used and disclosed. See the Fund’s website and

instructions on how you can obtain a copy of the Privacy Notice, which may also be downloaded from the Fund’s website at:

www.scmebf.org.

For a printed copy of the Fund’s Privacy Notice, please write to :

Cheryl A. Felice, Privacy Officer

Suffolk County Municipal Employees Benefit Fund

30 Orville Drive, Suite D,

Bohemia, New York 11716-2513

631-319-4099, ext 319

SCME BENEFIT FUND - RIGHT TO APPEAL

The benefits provided by this Fund may be

changed by the Board of Trustees at any time, in their sole and absolute discretion. The Board of Trustees adopts rules and

regulations for the payment of benefits. All provisions of the Benefit Reference Guide

(BRG) are subject to such rules and regula-tions and to the Trust Agreement, which

established and governs the Fund operations. All benefit and eligibility rules are uniformly applied by the Fund office and Third-Party

Administrators. The actions of the Fund or its Administrators are subject to review by

the Board of Trustees. A member or beneficiary may request an

APPEAL of any action by submitting a writ-

ten request to the Board of Trustees within

180 days of the last determination:

Suffolk County Municipal Employees

Benefit Fund

Attn: Board of Trustees, for Appeal

30 Orville Drive, Suite D

Bohemia, New York 11716-2513

The Trustees shall act on the appeal within a

reasonable period of time and render their conclu-sive decision in writing, which shall be final and binding on all persons.

Prescription Drug Co-Pay Reimbursement Benefit


File for Your Prescription Drug Co-Pay Reimbursement Benefit By way of reminder, the Prescription Drug Co-Pay Reimbursement Benefit for

expenses incurred in 2015 is as follows:

Active Members, Active Level (Full) COBRA participants and “Self-Pay” Enhanced Retirees in the Premium Plus and Platinum Plans will enjoy reimbursement for prescription drug co-pay expenses incurred on or after January 1, 2015 and payable beginning January 2016.

Prescription Drug Co-Pay Reimbursement under the new guidelines will continue as follows:

Up to $20 per eligible script (must be a covered drug in the EMHP Plan) Up to $350 per family PLUS ; $1.00 additional for each eligible script over $350/per family. Reimbursement will be made in the order of prescription fill-date only. Rx claim form and prescription history print-outs required for all claims.

You can still file a claim for your 2014 Prescription Drug Co-Pays as long as you submit it or have it postmarked by December 31, 2015 to

be eligible for the 2014 Reimbursement. Don’t delay, file today!

Exceptions to the Prescription Co-Pay Reimbursement Benefit The Prescription Drug Co-Pay Reimbursement Benefit IS NOT avail-

able to “No-Cost” Basic Retiree Plan members or Retirees in the “Self-Pay” Enhanced Retiree Premium Plan.

This benefit is for ACTIVE members, members on Full COBRA and retirees enrolled in the “Self-Pay” Enhanced Retiree Premium Plus and Platinum Plans ONLY.

If you retired at any point within the year of 2015, you will be eligible for reimbursement for your Prescription Drug Co-Pays incurred through your last day on the payroll, up to plan guidelines, unless you enrolled in Full COBRA, or either the “Self-Pay” Enhanced Retiree Premium Plus Plan or the Platinum Plan whereby you be will eligible for reimburse-ment on all eligible co-pays.


OPTICAL VOUCHER REMINDERS FOR 2015

Optical Vouchers For 2015 Expenses

Vouchers issued after November 1, 2015, for your 2015

Optical Benefit EXPIRE on December 31, 2015, prior to the usual

60-day voucher limit.

To obtain your 2015 Optical Benefit, your glasses and/or con-

tacts must be ORDERED by December 31, 2015. Optical Vouch-

ers for 2015 claims delivered after January 1, 2016 will be covered

up to the reimbursable rate for eligible members and dependents if

your order for glasses or contacts was made on or before December

31, 2015.

The optical benefit is an annual benefit and becomes available

again on January 1, 2016. Call the Fund for your Optical Voucher

631-319-4099, DIAL 1 or visit the website at:

www.SCMEBF.org


WELCOME NEW TRUSTEES BRIAN MACRI, AME President,

and DAN LEVLER, AME Executive Vice President

With the July installation of Officers for

the SC Association of Municipal Employees, so too comes with it new Trustee designa-tions to the Board of Trustees of the Suffolk County Municipal Employees Benefit Fund.

Brian Macri, past Unit President from the Medical Examin-ers Unit and new AME President, was elected to a term of July 1, 2015 – June 30, 2018. By virtue of his presidency, he is the first new

Labor Trustee designee to the Fund, replac-ing Dan Farrell, past AME President.

Oversight of the Benefit Fund is a shared responsibility of an eight (8) member Board of Trustees comprised of four (4) who are appointed by the employer (County of Suffolk); one (1) of whom is the sitting president of AME and serves for the length of his/her Association's term of of-fice; and three (3) labor (Association) Trus-tees, ALL of whom are appointed by the AME President with approval of the Associ-ation’s Executive Board.

Each Association Trustee serves for a term of three (3) years, or until his/her

death, incapacitation, resignation or remov-al by a majority vote of the labor Trustees.

The next labor Trustee appointment made by the SC Association of Municipal Employees was Dan Levler, AME Executive Vice President, hailing from the Depart-ment of Public Works. Dan is filling the ex-pired term of Susan La Sala, past AME Sec-retary, past Unit President and past Dele-gate formerly of the DSS Unit and presently from the Family Service Unit.

A Trustee’s role is to act solely in the inter-est of the plan participants and their de-pendents for the exclusive purpose of providing or enhancing the supplemental benefits plans within the Trust Fund and Plan Guidelines. Both Brian and Dan join an esteemed group of Trustees, past and pre-sent, who served the Fund with pride since 1975, and under AME’s contract since 1985.

On behalf of all of us here at the Fund, we extend Brian Macri and Dan Levler our best wishes for successful terms of office as Trus-tees of the Suffolk Coun-ty Municipal Employees Benefit Fund!

REMINDER ON OPEN ENROLLMENT FOR "Self-Pay” Enhanced Retiree Plans

ENROLLMENT APPLICATIONS were sent to all retirees about the Fund’s Annual Open Enrollment. Since 2007, retirees are given the opportunity to “purchase” Fund dental plan benefits (and more) equal to the Active members full dental plan.

Applications must be notarized and returned to the Fund no later than December 31, 2015 for coverage on January 1, 2016. Members who are already enrolled in one of the “Self-Pay” plans DO NOT need to submit another notarized application, UNLESS they are dropping back to the “No-Cost” Basic Retiree Plan or changing the type of “Self-Pay” Plan they are currently in.

Retirees may also visit the Fund to enroll and to make plan payments by check or credit card. Subsequent credit card payments can be made by calling the Fund or on-line through the Fund’s Website at:

WWW.SCMEBF.ORG

Any questions or for a replacement application, please call either the

Eligibility Coordinator at 631-319-4099 ext. 321 or

Fund Administrator at 631-319-4099 ext. 319

Free Notary Services Available at the Fund


OPEN ENROLLMENT REMINDERS FOR RETIREES


PROVISIONS UNDER THE PATIENT PROTECTION AFFORDABLE CARE ACT

According to the IRS Website, www.irs.gov

The Individual Shared Responsibility Provision/Qualifying Health Care Coverage known as “Minimum Essential Coverage” under PPACA, the Patient Protection Affordable Care Act

The individual shared responsibility provision under PPACA requires you and each mem-

ber of your family to have qualifying health care coverage known as minimum essential cover-

age, or to qualify for an exemption from the responsibility to have “minimum essential coverage.

On pages 8-9 is a letter outlining the steps the Fund will take to comply with PPACA on

your behalf. You will receive a document from the Fund that is similar to an IRS W-2 form

known as a Form 1095-B. You may or may not need to attach documentation or proof of

insurance coverage verifying your “minimum essential coverage” to your tax return however, you

must show the form to your tax preparer.

The IRS may ask you to substantiate the information on your tax return with regard to

healthcare. Therefore keep these documents with your tax records and check with your tax

preparer for further instructions.

To: All Members of the Suffolk County Municipal Employees Benefit Fund

(SCMEBF)

From: Cheryl A. Felice, Fund Administrator

Date: December 10, 2015

Re: Federal Patients Protection Affordable Care Act (PPACA)

NEW REQUIREMENTS UNDER PPACA-

Starting in 2016, the “individual mandate” of the Federal Patient Protection

Affordable Care Act, known as the “ACA,” requires persons to have “minimum

essential” health coverage and requires health plans, including union-sponsored

supplemental benefit plans like those provided by the SCMEBF (“Fund”) to report

information to the IRS about certain health coverage it provided to you and your

covered dependents during 2015.

This information must be reported to the IRS annually on a new form, Form

1095-B, which you will receive from the Fund in early 2016. (You will likely receive

the same Form from your employer reporting on your “basic health insurance

coverage” provided in 2015.) The Form 1095-B provides information needed to

report on your income tax return (check with your tax preparer) that you, your

spouse (if you file a joint return), and individuals you claim as dependents had

“qualifying health coverage” (referred to as “minimum essential coverage”) for

some or all months during the year.

This new reporting requirement is in fulfillment of PPACA and the Internal

Revenue Code Section 6055. To accurately “match” the information provided to the

IRS with the information provided on your tax return, the Fund is required to have

ALL Taxpayer Identification Numbers (TIN’s) or Social Security Numbers (SSN’s)

on file for you and each of your dependents.



Letter on new provisions of the

Patient Protection Affordable Care Act

Page 2

WHY SOCIAL SECURITY NUMBERS (SSN) ARE NEEDED-

Maintaining Social Security Numbers is necessary for this reporting obligation

to provide proof to the IRS that you and your covered family members are receiv-

ing qualifying health coverage under the provisions of the Affordable Care Act,

thereby avoiding tax penalties for both you and the Fund. This is a Federal mandate

the Fund and you cannot ignore. If you do not provide your SSN or other TIN and

the SSN’s or other TIN’s of all covered individuals to the sponsor of the coverage,

(the Fund) the IRS may not be able to match the Form 1095-B to you or your de-

pendents to determine compliance with the provision of PPACA.

WHAT TO EXPECT-

In the event the Fund was not supplied with the Social Security Numbers for any

of your dependents, you will be contacted to include the Social Security number on

a new enrollment card. You will ONLY be contacted by the Fund if a social security

number is missing for one or more of your dependents. Otherwise, you will not be

contacted until early 2016 when you receive a copy of the Form 1095-B. Your

privacy and confidentiality will be maintained at all times in accordance with

HIPAA.

Your cooperation is anticipated and appreciated, thank you.

Very truly yours,

Fund Administrator

COLLEGE VERIFICATION & KEEPING THE FUND UP-TO-DATE


Keep Enrollment Information Up-To-Date!

Fax or mail all changes in addresses,

phone numbers dependents, and

changes in marital status, (include the divorce decree)

to: SCME Benefit Fund

“Attention: Eligibility” our FAX line is private & confidential

631-218-7970

If mailed, send to: 30 Orville Dr., Suite D, Bohemia,

NY 11716-2513 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Original Beneficiary Forms should be sent to your

Employer/Department or Payroll/Personnel or

Human Resource Division. A copy may be sent to the Fund.

COLLEGE VERIFICATION DATES

To accommodate the hustle and bustle of post education enrollment verification between semesters for your dependent students ages 19-25 , the SCME Benefit Fund College Verifi-cation was simplified and remains as follows:

FALL Semester - coverage from September 1st - January 31st

SPRING Semester - coverage from January 1st - September 30th

Should you have any questions or concerns, please contact: Eligibility Coordinator at 631-319-4099 ext. 321

DIVORCE DECREES ARE NEEDED AT THE FUND TOO!

When dealing with the hardship of a divorce, make sure you timely notify the Fund of the date your spouse should no longer be covered under your supplemental benefit fund plan. Failing to notify the Fund of a change in your marital status and permitting your ex-spouse to continue to use and claim ben-efits after they are no longer eligible, puts YOUR BENEFITS at risk.

Remember, it is the member’s responsibility to reimburse the Fund on claims paid to an ineligible former dependent. Failure to repay any overpay-ment may result in suspension of benefits for you and your eligible depend-ents, until the repayment is satisfied. So don’t delay, contact the Fund with any changes in the status of your dependents as soon as they become known.

Quick Reference Guide of Phone Numbers & Websites

BENEFIT FUND

SC Municipal Employees Benefit Fund SCMEBF fax number Fund Email Contact

Fund Administrator Emergency/Urgent Voice Mail

www.scmebf.org [email protected] (list type of inquiry in the memo line)

[email protected]

1-631-319-4099 1-631-218-7970

1-631-319-4099 Ext. #319

DENTAL - 3rd-Party Administrator Healthplex, Inc. (Customer Service) Healthplex Email Contact Benefits and Dental Claims Supervisor at the Benefit Fund

www.healthplex.com [email protected] [email protected] (list type of inquiry in the memo line)

1-888-468-5178 1-631-319-4099 Ext. #0

EMHP (Health Benefits) Enrollment and Eligibility Employee Benefit Unit Email & Phone

Employee Medical Health Plan www.emhp.org [email protected]

1-631-853-4866

DOCTOR/HOSPITAL Empire Blue Cross Blue Shield 24-Hour Nurse Talk Line Out-of-State Network Providers

www.empireblue.com/emhp www.bcbs.com

1-800-939-7515 1-877-Talk2RN 1-800-810-BLUE

PRESCRIPTION BENEFITS Express Scripts (for Medicare Retirees) Prescription Waiver Forms WellDyneRx (ID# on Card begins after “SC”)

www.express-scripts.com Handled with your doctor and WellDyneRx

emhp.welldynerx.com

1-800-950-2662 1-855-799-6831

MENTAL HEALTH BENEFITS Value Options (Mental Health)

www.valueoptions.com

1-866-909-6472

LAB WORK QUEST Diagnostics for all LI Sites QUEST Diagnostics Automated Appointment Scheduling

www.questdiagnostics.com www.questdiagnostics.com/scheduling

1-800-877-7484 1-888-277-8772

PARTICPATING UNIONS SC Association of Municipal Employees

(Suffolk County Community College and Westhampton Village Highway)

SC Probation Officer’s Association SC Deputy Sheriff ’s PBA SC Correction Officer’s Association

www.scame.org www.scpoa.org www.scdspba.net www.sccoa.net

1-631-589-8400 1-631-654-2080 1-631-289-1768 1-631-208-1301

NYS RETIREMENT SYSTEM www.osc.state.ny.us/retire/ 1-518-474-7736


Ancillary coverage from the Benefit Fund,

SCMEBF is separate from your Employer-Sponsored

Health Plan, EMHP.

Inquiries about your Health

Plan for:

Prescriptions Claims WellDyneRx

I.D. Cards Blue Cross Lab Work

Behavioral Health should be directed to: Employee Benefits

Unit at 631-853-4866

or email to: [email protected]

For Prescription information call:

WellDyneRx 1-855-799-6831

For Emergency Issues Anytime, call 631-319-4099, ext. #319

PRESORTED FIRST CLASS

U.S. POSTAGE PAID CENTEREACH, NY

PERMIT NO. 5

BOARD OF TRUSTEES

TRUSTEES JEFFREY L. TEMPERA

Chairperson ~

DENNIS M. BROWN JENNIFER K. MCNAMARA

FRANK NARDELLI

TRUSTEES BRIAN MACRI

Vice Chairperson ~

DANIEL C. LEVLER MICHAEL J. FINLAND

CONI LORENZEN

CHERYL A. FELICE, FUND ADMINISTRATOR Emergency Voice Mail 631-319-4099 ext. 319

PHONE (631) 319-4099 FAX (631) 218-7970 www.scmebf.org

Email Inquiry Address - [email protected]

To the extent that this newsletter describes any benefit provided by this Fund, which is already described in the Fund’s comprehensive Benefits

Reference Guide, or as amended in subsequent writings issued by the Fund, or a policy of insurance (e.g., life insurance), the language of the Benefits

Reference Guide, as amended, and/or the group insurance contract, which specify the exact benefits provided, will govern in the event of

inconsistency between it and the language of this newsletter.

30 Orville Drive, Suite D Bohemia, New York 11716-2513

Suffolk County Municipal Employees Benefit Fund Joint Labor - Management Trust

Documents

Suffolk County Municipal Employees · to make plan payments by check or credit card. Subsequent credit card payments can be made by calling the Fund or on-line through the Fund’s