Know your benefits

Special coordination of benefits

Mar 13, 2008 3:00 PM

You can save money if your spouse or domestic partner is also a UFT member

If you and your spouse or domestic partner are both UFT members, you don’t have to choose one or the other’s benefits — you have the benefit of both when it comes to certain Welfare Fund benefits. With special coordination of benefits, you can receive dental, optical, prescription drug and hearing aid benefits from each other’s coverage.

Dental benefits

In the case of dental work, special coordination of benefits can decrease your family’s out-of-pocket costs if you and your spouse or domestic partner are both enrolled in the Scheduled Benefit Plan and you go to a non-panel dentist who charges more than the UFT’s Schedule of Covered Dental Expenses. You will be reimbursed at up to twice the fee schedule as long as the reimbursement does not exceed the dentist’s actual charges. To obtain special coordination of benefits, do not assign payment of the dental benefits directly to your dentist and check the appropriate box at the top of the dental claim form.

Be aware that special coordination of benefits does not change the frequency caps for dental work, i.e. once every six months for a checkup and once every three months for cleaning.

A second option is to enroll your family in Dentcare, a no-cost dental HMO, and the Scheduled Benefit Plan. You and your family can go to a Dentcare dentist and avoid all out-of-pocket dental expenses, to one of the UFT’s panel dentists or to a non-panel dentist. This approach does not result in overlapping benefits, but it does give you more flexibility. All the regular co-pays, fee schedules and rules would apply.

Optical benefits

UFT members and their spouses or domestic partners who are also UFT members can save on eyeglasses as well. There are two ways you can use this special coordination of benefits. You can either use two certificates at the same time toward one or two pairs of glasses, or use one certificate this year and the other next year.

When you present these two certificates to the optical store, you can get up to two times $75 (the value of the certificate), which is $150 off the cost of your eyeglasses or pay nothing if the glasses cost less than that. You are entitled to additional discounts if you buy from a participating provider.

It is important when you call the Welfare Fund’s automated forms hotline at 1-212-539-0539 that you order the first optical certificate under your ID number and your spouse orders the second certificate for you as his or her dependent under the spouse’s ID number.

Prescription drugs

Under special coordination of benefits, the in-service annual maximum benefit per family per calendar year for prescription drugs rises from $100,000 to $200,000. The Fund will not enroll you in its Cost Care Program until your family’s combined prescription drug claim benefits exceed $2,400 during the previous 12 months, instead of $1,200. Also, under the new cap on prescription drug co-pays ($1,000 annually), your entire family’s co-pays are used to calculate the cap. Once your family co-pays reach $1,000 in out-of-pocket expenditures, the rest of your drugs are free for the year.

Hearing aid benefit

You or a family member would also be entitled to direct reimbursement of up to $500 per hearing aid. You can either use the $500 reimbursement for one hearing aid this year and another next year or use both certificates at the same time for the purchase of two hearing aids. The two certificates cannot, however, be combined when purchasing one hearing aid.

Similar to the optical benefit, it is important when you call the Welfare Fund’s automated forms hotline at 1-212-539-0539 that you order the first hearing aid certificate under your ID number and your spouse orders the second certificate for you as his or her dependent under the spouse’s ID number.