Many of us are rightly focused on the salary increases and retroactive pay that CUNY is finally paying this month, but another important financial benefit of the new contract has already begun. As of January 1, 2017, Welfare Fund dental, vision and hearing benefits have been substantially improved for all Fund participants, including full-time faculty and staff, retirees, adjuncts who receive NYC health insurance through CUNY, and eligible dependents. The improvements are a direct financial benefit because they lower the costs of essential care, allowing you to keep more of your salary.
How are such improvements possible in this age of austerity, especially austerity in health care? Because PSC members fought for them and won when we insisted on a non-austerity contract. And because the union campaigned for more than a decade to have CUNY – not the Welfare Fund – provide health insurance for eligible adjuncts, as it does for full-timers. These union victories, together with careful management by the Welfare Fund staff, have made possible the most substantial benefit improvements the Fund has made in years.
Take a look below at the difference the improved benefits could make for your own health and finances.
- Prescription lenses, including progressive lenses, high-index lenses, ultra-thin lenses, UV-coated lenses and many other specialized lenses, are now available at network providers at no cost every 24 months. Many members will save hundreds of dollars on glasses or contacts.
- In-network reimbursements for expensive dental procedures such as crowns and root canals will increase substantially. If you use a Guardian dentist, 60 to 75 percent of the cost will be covered, depending on the procedure.
- The cost of hearing aids has dropped dramatically, as the Welfare Fund has negotiated a new range of in-network prices and doubled the previous subsidy for this benefit available every 36 months.
CUNY faculty, staff and retirees who use in-network benefits will have access to full-service dental, vision and hearing care at a cost that we hope will be within financial reach, and in some cases, at no cost.
The Welfare Fund is supported by money CUNY receives from New York State and New York City, negotiated by the union through the contract. One of the ways our new contract does more than simply keep up with inflation is by enhancing essential benefits.
The PSC is one of very few unions that has been able to win enhanced health benefits for our members in this period of artificial austerity. We are also one of the few public-sector unions in New York City committed to maintaining the same benefits for retired and in-service members, and almost unique in securing new supplemental health benefits for eligible adjuncts. All of us should be proud of these commitments; they are part of the union’s practice of fighting for equity and fairness. Health benefits affect us all and are an equity issue: the same $500 saved on dental or eyeglass costs represents a larger portion of salary for lower-paid members than for higher-paid ones.
IN THE NETWORK
The key to all of the enhancements is the provider network. The benefit improvements are based on the principle that a large group, such as ours, has power to negotiate for the best quality and value when we work with a network. Most of us are familiar with the concept of in-network health providers from our primary health insurance. The same concept applies here. While the Welfare Fund also increased out-of-network reimbursements as of January 1, the biggest increases are for in-network care.
I urge you to learn about the new benefits and use the networks. On the website, enter your ZIP code and look up the opticians in your neighborhood who participate in our network; you may be surprised to learn, as I was, that the independent optician you currently use already participates in the Welfare Fund network. Your lenses or contacts at an in-network optician may now be free, and selected frames will also be free. Or consider switching to a Guardian dentist, at least for expensive specialized procedures like root canals or for children’s orthodontia. On the website, using PPO as our plan, find a Guardian dentist or specialist convenient for you. You could save hundreds of dollars. If you have been hesitant to try a hearing aid because of the cost or complexity, try the Welfare Fund network; it provides unlimited adjustments during the first year and insurance against loss.
Contractual health benefits are especially precious now with the Affordable Care Act targeted for repeal and uncertainty about its replacement. The Welfare Fund trustees, who include members from CUNY management as well as the PSC, are acutely conscious of potential health policy changes and took a fiscally conservative approach to enhancing benefits. We will continue to monitor the impact of any policy changes and will preserve the financial stability of the Welfare Fund. The trustees also determined that the greatest impact on members’ lives with the money available could be achieved by addressing the dental, vision and hearing benefits rather than the prescription drug plan. The Fund recently switched to a new pharmaceutical provider, CVS Caremark, and needs more experience with the provider before considering other investments.
GETTING THE INFO
Details about the benefits were sent last December by the Welfare Fund, are posted on the Welfare Fund website, and will appear in brochures being sent to you by each of the network providers. Please read them carefully and don’t hesitate to call the Welfare Fund at (212) 354-5230 if you have questions.
Use the benefits, stay well, and keep in fighting trim! We will need our entire collective strength to protect our health, our salaries, our students and our profession in the years ahead.
Summary of benefit enhancements
The new benefits are available to all participants in the PSC-CUNY Welfare Fund: adjuncts on NYC health insurance, in-service and retired full-timers and eligible dependents.
Dental: Guardian DentalGuard Preferred Network
As of January 1, 2017, members and their dependents participating in the Guardian dental plan will see a substantial increase in the amount the Fund pays the dental provider (reimbursement schedule) for most dental procedures, such as crowns, dentures, child orthodontia and implants, when obtained through a Guardian-participating provider. For those who use Guardian dentists, out-of-pocket costs for many dental procedures will decrease significantly for procedures performed on or after January 1, 2017.
GREATER DENTAL REIMBURSEMENTS
Guardian network dentists charge substantially less than their usual and customary fee to Guardian-participating members. As of January 1, 2017, the Fund has increased the reimbursement schedule for Guardian providers with the expectation that members who receive treatment from a Guardian dentist will have, on average, 60 to 75 percent of their costs covered, depending on the procedure.
The out-of-network reimbursement schedules are also enhanced for some emergency, non-preventive procedures (e.g., fillings and root canals).
The reimbursement schedules for preventive services, such as cleaning and exams, remain unchanged for both in- and out-of-network providers. For in-network preventive procedures, the previous reimbursement schedule met, on average, 80 percent of costs.
The new reimbursement schedules are in effect as of January 1, 2017. Full details are available on the Welfare Fund website. Delta Dental HMO participants will continue under the current plan terms.
Vision: PSC-CUNY Welfare Fund Davis Vision Premier Collection
The Fund has contracted with Davis Vision to be the exclusive network provider for glasses and contact lenses. For most prescriptions, members who use the extensive network of Davis Vision providers will be able to obtain an eye exam, frames and lenses, and contact lenses free of charge. Members who choose to use non-network providers for vision correction are eligible for a $200 direct reimbursement, which is double the previous amount.
The Davis Vision network includes their own stores called Visionworks and also a large number of participating in-network private practice opticians and optometrists throughout the metropolitan area and nationally. A full list of participating providers is available on the Davis Vision website. Some members may find that their current provider is already in the Davis Vision network. Retirees who live outside of New York State are already covered under a Davis Vision exclusive network plan.
EVERY 24 MONTHS
The full range of Davis Premier Collection eyeglass frames and Premium Collection contact lenses is available free of charge. Photo-sensitive lenses, premium progressive lenses, ultra anti-reflective coating and many other enhancements are also included free of charge.
If you use an in-network vision provider and select a frame that is not in the Davis Premier Collection or contact lenses that are not in the Davis Premium Collection, you will receive a discount on the frames or contacts, plus a store credit. Full details are available on the Welfare Fund website. If you use a non-network provider, you will be eligible for a direct reimbursement once every 24 months at the new level of $200.
FREE FRAMES AND LENSES
Vision Benefits are available to all covered members and dependents once every 24 months. Eligible dependent children under 19 years old, however, are eligible for benefits once every 12 months, but only when the off-year services are rendered by a participating Davis Vision provider.
As of January 1, 2017, the Fund has ended its contract with General Vision Services. Members who wish to continue using their GVS provider will still be able to apply for the $200 out-of-network member reimbursement.
Hearing: HearUSA Network
On January 1, 2017, the Welfare Fund introduced a major improvement in its coverage of hearing aids. The Fund has contracted with HearUSA to be an exclusive network provider of hearing aids. HearUSA has a national network of 4,000 providers, including HearUSA stores and private-practice audiologists. Members and their eligible dependents are eligible for either an in-network or an out-of-network benefit once every 36 months.
The new benefit works for Welfare Fund participants and their eligible dependents in five ways:
- The Fund has contracted for reduced prices on high-quality hearing aids through the HearUSA network and has increased the amount the Fund will contribute towards the purchase. The former plan coverage was often insufficient to cover expenses for even one hearing aid. Audiologists have advised that the best practice is to provide two hearing aids even if there is hearing loss in only one ear.
- HearUSA has guaranteed a discounted price on all hearing aids for covered Welfare Fund participants and their eligible dependents. The discounted prices range from $895 to $2,250 per hearing aid, depending on the features selected. These prices represent a substantial discount from market prices; for example, a premium hearing aid averages $4,000 for each ear.
- In addition to the lower prices negotiated by the Fund, the Fund will also subsidize the cost of an in-network hearing aid. The Fund will contribute up to $750 per hearing aid, regardless of the cost, for a total subsidy of $1,500. That amount represents a doubling of the current in-network benefit.
- The Welfare Fund has negotiated with HearUSA a number of service guarantees, including three years of free batteries and a 60-day trial and return policy. HearUSA will also provide a “loaner” hearing aid should your hearing aid malfunction and need to be repaired. HearUSA covers 11 different manufacturers and maintains extensive quality control measures.
- Some Fund participants who purchased hearing aids using the Fund’s previous, much-lower subsidy within the last two years may want to purchase new hearing aids in 2017. For such members who purchased hearing aids in 2015, a $500 voucher is available. For members who purchased hearing aids in 2016, a $750 voucher is available. Vouchers may be used only toward the purchase of new hearing aids in 2017.
Members who decide to go out of network will continue to be eligible for a maximum $500 direct reimbursement. As of January 1, 2017, the Fund has ended its contract with General Hearing Services.