New York State provides vision and dental benefits at no cost to employees who meet the eligibility requirements for participation in the New York State Health Insurance Program. These benefits are available to you and your eligible dependents whether you enroll for individual or family coverage in the Health Insurance Program or decline health insurance coverage. Dental and vision care coverage is not automatic; you must first enroll yourself and your dependents.
Detailed information about eligibility requirements for you and your dependents, covered benefits, and instructions on how to use your plans may be found at www.cs.ny.gov/employee-benefits/login/.
Dental Care
EmblemHealth
PO Box 12365
Albany, NY 12212
www.emblemhealth.com/nyship
Group # 954
1-800-947-0101
Eligible members and dependents are covered for two routine examinations and cleaning of teeth and four bitewing x-rays per calendar year. Other procedures will be covered following a $25 per person per year deductible. Total Family deductible will not exceed $75 per year for all covered family members. The amount credited towards the deductible is based on EmblemHealth’s Schedule of Allowances, not the amount charged by the dentist or physician. Dental Services rendered by participating and non-participating providers are covered to the extent that they are a covered service, are necessary for dental health, and are performed by a licensed dentist or physician. When covered services are rendered by non-participating providers, you are reimbursed based on the Reimbursement Schedule. When rendered by participating providers, these dental services are covered on a paid-in-full basis. Dependent children who are age 19 or older, but under age 25, are eligible if they are full-time students. Student verification will be required.
Vision Care
Davis Vision
711 Troy Schenectady Road
Latham, NY 12110
www.davisvision.com
1-888-588-4823
Eligible members and dependents age 19 and older are entitled to vision services once every 24 months (from the last month of benefits received). Dependent children who are age 19 and older, but under age 25, are eligible if they are full-time students. Student verification will be required. Dependents under age 19 are covered once in any 12 month period. When using a network of participating providers, the benefit includes an eye exam and one pair of glasses without co-payment (from a select frame assortment) or plan-covered contact lenses with either a $25 or $45 co-payment (based on the brand of contacts selected). A list of participating providers is available from Davis Vision. If you choose to use a non-participating provider, you will be eligible for a partial reimbursement towards the cost of your exams, glasses, frames or contact lenses.
To obtain forms, please visit www.davisvision.com to register.
How do I enroll?
To enroll, complete the dental and vision portion of the Health Insurance Transaction Form (PS-404) and return the completed form to the Employee Benefits Office, Cleveland Hall 403.
Some content on this page is saved in PDF format. To view these files, download Adobe Acrobat Reader free. If you are having trouble reading a document, request an accessible copy of the PDF or Word Document.
