OVERVIEW OF YOUR BENEFITS
IMPORTANT PHONE NUMBERS
Member Services Department
(646) 473-9200
For answers to questions about your
benefits or to be referred to another
Benefit Fund department.
Program for Behavioral Health
(646) 473-6900
For mental health and alcohol/
substance abuse.
1199SEIU CareReview Program
(800) 227-9360
For Prior Approval of hospital stays.
You can also visit our website
at www.1199SEIUBenefits.org
for forms, directories and other
information. From our website, you
can also click on “My Account” and
create your own account to check
your eligibility, find out whether a
claim has been paid, change your
address or update other information.
The Benefit Fund has no pre-existing
condition exclusions. A pre-existing
condition is a medical condition,
illness or health problem that existed
before you enrolled in the Fund.
Eligibility Class I and II have an annual
restriction on out-of-pocket costs,
which includes co-payments, as
required by the Affordable Care Act.
OVERVIEW OF ELIGIBILITY CLASS III BENEFITS
Eligibility Class III: Part-time members who work more than 20%, but less than
60%, of a full-time schedule (generally more than one, but less than three days
per week)
The following is a quick reference guide that gives you an overview of your
benefits. Do not rely on this chart alone. Please read the rest of this SPD for a
full explanation of each benefit.
Benefit Coverage
Eligibility Class III (Member Only)
MEMBER CHOICE
COMPREHENSIVE
DENTAL BENEFIT
•
•
100% of the Benefit Fund’s
Comprehensive Schedule
of Allowances for basic and
preventive services
Maximum benefit of $1,200 per
year (excluding essential oral
pediatric services)
You must call DDS at (800) 255-5681 for
Prior Approval of treatment over $300.
See Section II.K of this SPD for
more details.
VISION CARE
•
One eye exam every two years
•
One pair of glasses or contact
lenses every two years
See Section II.J of this SPD for
more details.
LIFE INSURANCE/ACCIDENTAL
DEATH AND DISMEMBERMENT
•
Life insurance amount of $2,500
See Section IV of this SPD for
more details.
DISABILITY
•
This benefit is provided by
your Employer
•
Fund coverage up to a maximum of
26 weeks within a 52-week period
See Section III of this SPD for
more details.
Benefit Coverage
HOSPITAL INDEMNITY PAYMENTS
•
Up to $200 (less applicable
taxes) for each day you are an
inpatient in a hospital as defined
in Section IX of this SPD
•
Up to a maximum of 10 days per
hospital stay
•
You must be billed for a room
and board charge on your
hospital bill
SOCIAL SERVICES
•
Member Assistance Program
•
Citizenship Program
•
Earned Income Tax Credit
Assistance Program
•
Home Mortgage and Financial
Wellness Program
Eligibility Class III (Member Only)