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 advantage of both when it comes to certain UFT Welfare Fund benefits. With special coordination of benefits, you can receive enhanced dental, optical, hearing aid and prescription drug benefits from each other’s coverage.
If you and your spouse or domestic partner are both enrolled in the Scheduled Benefit Plan and you go to a nonpanel 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 this special coordination of benefits, do not assign payment of the dental benefits directly to your dentist; instead, check the appropriate box at the top right of the dental claim form and add your spouse’s Social Security number.
Also, members who are eligible for the special coordination of benefits and use a participating dentist will not be charged the co-pays listed on the Fund’s dental schedule. The Fund will pay those co-pays. However, the member will still be responsible for paying for upgraded or noncovered services.
You also have the option to enroll your family in Dentcare, a no-cost dental HMO under one member and use the Scheduled Benefit Plan under the other member. Using this option, you and your family members may use either a Dentcare dentist at no cost or a panel dentist whose services would be reimbursed according to the Scheduled Benefit Plan.
Be aware that special coordination of benefits does not change the frequency caps for dental work, such as once every six months for a checkup and once every three months for cleaning.
If you and your spouse or domestic partner are both UFT members, there are two ways you can use the special coordination of benefits to save on eyeglasses. You can either use two certificates at the same time toward one or two pairs of glasses, or you can 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 the $125 value of the certificate, which is $250, 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.
To access this special coordination of benefits, you must order the first optical certificate under your ID number and your spouse must order the second certificate for you as his or her dependent under the spouse’s ID number.
Hearing aid benefits
You or a family member is also entitled to direct reimbursement of up to $1,000 per hearing aid. You can either use the $1,000 reimbursement for one hearing aid this year and another next year or combine both certificates at the same time for the purchase of one or two hearing aids.
You must order the first hearing aid certificate under your ID number and your spouse must order the second certificate for you as his or her dependent under the spouse’s ID number.
Prescriptions for in-service members
Under special coordination of benefits, the Fund will not enroll you in its Cost Care Program until your family’s combined prescription drug claim benefits exceed $2,400, instead of $1,200, during the previous 12 months.
Also, under the maximum out-of-pocket cap on prescription drug co-pays ($1,000 annually), your entire family’s co-pays are used to calculate the cap. Once your family’s total co-pays reach $1,000 in out-of-pocket expenditures, the drugs in Tier I (generic) and Tier II (preferred brand) are free for the year.