The Part Time Pus plan provides ancillary benefits which include dental, vision and life insurance (including Accidental Death & Dismemberment).
How can I get a new or another dental or vision plan ID card?
If you have not received a Delta Dental ID card for your dental benefits or your Davis Vision ID card for your vision benefit or need an additional ID card for a dependent please call Member Services at 800-551-3225.
How do I know if a health service is covered?
You should review your Summary Plan Description (SPD) for detailed coverage of your benefits. If you have additional questions contact Member Services at 800-551-3225.
Are my dependent(s) eligible?
Yes, if your collective bargaining or participation agreement provides for family coverage. In general, your covered dependent(s) include your spouse and your children until they reach 26 years of age (refer to your (SPD) for more information).
What do I have to do to cover my dependent?
- Fill out and return the appropriate form.
- Provide documentation that proves that individual you want to enroll is your dependent. For example, you must provide a marriage certificate to cover your spouse or a birth certificate for a dependent child.
Call Member Services at 800-551-3225 for more information.
Click here to access the Dependent Enrollment form
What happens if I have a change in my life (like marriage, birth of a child or divorce)?
You must:
- Notify the Fund within thirty (30) days of the date of the event or marriage or birth.
- Fill out and return the appropriate form.
- Provide documentation proving the relationship.
If you notify the Fund within thirty (30) days, your dependent will be covered from the date of the event (birth, adoption, marriage). If you do not notify the Funds within thirty (30) days of the event, your spouse/child will only be covered prospectively from the date you notify the Fund.
Do I need to enroll to be covered for benefits?
No, you are automatically enrolled in benefits but you will need to enroll your eligible dependents.
What does my dental benefit cover?
The Dental Plan through Delta Dental covers a wide range of dental services, including:
- Preventive and diagnostic services, such as routine oral exams, cleanings, x-rays, topical fluoride applications and sealants,
- Basic therapeutic and restorative services, such as fillings and extractions,
- Major services, such as fixed bridge work, crowns, dentures and gum surgery, and
- Orthodontic services, such as diagnostic procedures and appliances to realign teeth
Dental benefits are subject to frequency limits and there is an annual maximum of $2,000 per person for dental care. There is no annual maximum for participants or dependents under age 19. Refer to your SPD for detailed information.
Which dentists can I see and what will I pay when I see a dentist?
Your Delta Dental Plan has a large network of participating PPO dentists throughout the country. When you use a participating PPO dentist most services are covered in full. You can find a participating Delta Dental PPO dentist near you by searching Delta Dental or contacting Delta Dental at 800-589-4627.
You can also use a non-participating dentist but you will need to submit a claim to Delta Dental for reimbursement. Delta Dental will reimburse you directly up to what Delta Dental pays an participating PPO dentist for those services. You are responsible for any balance billing from the non-participating dentist.
Consult your SPD or call Member Services at 800-551-3225 for more information.
Where can I get a vision exam and glasses if I need them?
All in-network vision coverage is provided through Davis Vision which has thousands of participating providers throughout the United States. Contact Davis Vision at 800-999-5431 for assistance in locating a Davis Vision provider near you or to find an in-network Davis Vision provider please go to Davis Vision.
There is an out-of-network benefit for participants and dependents over age 19, but you will have to pay charges in full and request reimbursement for the allowed amount.
How much will I pay for an exam and glasses?
If you use a Davis Vision participating provider, you can get an exam and glasses with no out-of-pocket cost. Your choice of frames and lenses will be limited to the Plan’s wide selection at Davis Vision. If you want frames and/or lenses outside of the Plan’s selection you will need to pay the difference.
If you use a non-participating provider, you can get reimbursed up to $30 for eye exams, $60 for lenses and $60 for frames. You are responsible for paying the charges in full and requesting reimbursement directly from Davis Vision for up to the allowed amounts.
Can I choose to get contacts instead of glasses?
Yes, but the maximum allowance for contacts is $120.
How often can I use my vision benefit?
The vision benefit is payable once in any 24 month period, starting with the date you first incur a vision care expense (typically an eye exam). Participants and dependents under 19 are eligible once every 12 months.
If I change 32BJ employers within the school district, what happens to my health coverage?
If you change covered employers and you have a break of 91 days or less in employment, your coverage will begin on your first day back to work. If there is more than a 91 day break in employment, your coverage will not begin until you complete 90 consecutive days of employment with your new covered employers (refer to your SPD for more information).
If I leave the industry, how long can I stay on the health coverage?
Your coverage will continue at no cost for 30 days after your last day worked in covered employment. Prior to the expiration of the 30 days, you will be offered under the Consolidated Omnibus Budget Reconciliation Act of 1986 (“COBRA”) the opportunity to purchase dental and vision coverage for up to 17 more months.
What happens to my health coverage if I become disabled?
If you are eligible, the Fund will pay continued health coverage (Fund-paid Health Extension). This coverage counts toward the time you are eligible for COBRA. To be eligible, you must:
- Have become disabled (either totally or totally and permanently) while working in covered employment.
- Be unable to work.
- Be receiving (or be approved to receive) one of the following benefits:
- Short-term Disability (“STD”).
- Worker’s Compensation.
- Long-Term Disability (“LTD”) under the Metropolitan Plan.
- Building Service 32BJ Pension Fund Disability Pension.
If you are covered by the Part Time Plus plan, your coverage may be extended for up to six (6) months.
What happens to my family’s coverage if I die?
If your family is enrolled/covered on the date of your death, their coverage will continue at no cost for thirty (30) days. Prior to the expiration of the thirty (30) days, your family will be offered the opportunity to continue coverage under COBRA for 35 more months by paying a monthly premium. COBRA coverage is very expensive because you pay the entire premium. Before you elect COBRA, you should go to www.Healthcare.gov to learn what options may be available to you in the Healthcare Marketplace.
Who do I call if I have questions?
Call Member Services at 800-551-3225 Monday through Friday between the hours of 8:30am to 5:00pm. Or visit the Welcome Center at 25 West 18th Street, New York, NY 10011, Monday through Friday between the hours of 8:30am - 6:00pm.