Dental and Vision Insurance through the Cornwall Central Teacher's Union
Benefit Trust Fund
Here is a rundown on how our dental and vision insurance works. Dental/Vision coverage is not through your medical/health benefits and is not administered by the school district. Our local teachers union is responsible to manage the funds for dental and vision coverage through what we call the benefit trust fund (CCTA BTF). Currently the BTF trustees are:
Mary MacLeod - Chairperson
Michael Flannery - Treasurer/Membership Enrollment email@example.com
Michele Powell - Secretary/Retiree liaison
*Contact Mary or Mike regarding any questions or concerns that you have about our dental or vision plan.
As long as you are a CCTA union member, you are eligible to receive this insurance and there is no cost to you. However, you must complete the enrollment forms as described below.
Ameritas is the company that handles all of the paperwork for our dental claims.
You will need to complete an enrollment form. The link to all forms and resources is:
Click on forms and print out the enrollment form for NY Dental. Complete the enrollment form and get it back to me at the high school either through interoffice mail or you can scan it in the copier and attach it as an email to firstname.lastname@example.org
I also attached a dental enrollment form to this document, but it is a good idea for you to visit the Amertias site. You can even register with them and use it to check on claims, etc.
Dental Enrollment form for Ameritas.pdf
You can fill in the Policy and Div. # 026-301533-00001
You can leave Cert# blank
Alternate Link to Dental Enrollment Form: Link to Dental enrollment form:
Many dentists will bill Ameritas directly. If your dentist does not, there is a claim form on the Ameritas website on the same resource page.
Vision enrollment is through a company called Brown and Brown, you will need to complete the vision enrollment form. The form is attached here:
Vision Enrollment form for Davis.pdf
Again, complete this form and return it to me.
Although Brown & Brown handles our vision paperwork, our vision claims are through Davis Vision. You can ask your provider if they take this insurance. If not you can find the claim form on our CCTA website.
Under our current plan, our members are free to utilize the services of any vision care provider of their choosing. However, the new plan will also provide for enhanced benefits when a member uses a provider that is a part of the Davis Vision network.
Please use the Davis Vision reimbursement claim form. You only need this form if your provider does NOT accept Davis Vision.
To view the Solstice/Davis Vision Plan Benefits Summary click here.
Davis Vision Network Resources
To locate a Davis Vision provider you have two options. The easiest and most direct way is to use the "Locate A Provider" menu at www.solsticebenefits.com then "Select a Product" and "Select a Plan". You may also go directly to the Davis Vision website which will then transfer you to the Solstice website.
*Please note that you will be required to register with your Davis Vision Card ID# if you choose to use the Davis website to locate a vision provider.
Changes to Enrollment
If a benefit trust fund member needs to make changes in dental or vision coverage, the member must contact the CCTA Benefit Trust Fund treasurer and complete a new amended enrollment form. Enrollment change forms must be completed for:
- change of marital status
- birth of a dependent
- maternity leave
*Note: It is essential that members contact the benefit trust fund treasurer regarding any new enrollments and/or changes as soon as possible to prevent delays in receiving claims reimbursements.
Members who are retiring are eligible to continue dental and vision coverage on a self-pay basis. Coverage under retirement will continue until the plan ceases or you fail to make the required payments. If coverage lapses due to failure to make timely payments, there will be no reinstatement. Retiree coverage is not automatic. You must complete an election form and return it to the benefit trust fund treasurer. Individuals who are retiring must notify the benefit trust fund treasurer three months prior to retirement. All forms must be completed and returned by the last day of employment.
A member may continue dental and vision coverage under COBRA when the member resigns from the district. Please contact the benefit trust fund treasurer for the necessary forms.
Please be informed that June 30 is the last day of the CCTA Trust Fund fiscal year.
Any enrolled dependent who is over age 26 will no longer be covered by the benefit trust fund after June 30. Please plan accordingly.
~ Dental and Vision COBRA Rates ~
Self Funded Dental (monthly premium)
Single Dental Family Dental
COBRA Fee 0.73 1.70
Admin. Fee 2.71 2.71
PPO Fees 1.28 1.28
Claim Cost 32.64 81.18
**Total 37.36 86.87
Fully Insured Vision (monthly premium)
Single Vision Family Vision
COBRA Rates 6.39 14.70
Carrier Billing Rate 6.26 14.41
Carrier Net Rate 5.56 11.62
*Totals 18.21 40.73
CCTA Benefit Trust Domestic Partnership Form (.pdf)file:///Users/mrbrevans/Documents/CCTA/Domestic%20Partnership.pdf
Cancer Screening Leave Form (.pdf)CancerScreeningLeaveForm.pdf
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