Q: What is the best way to contact a trustee?
A: Trustees can be contacted in person at their respective schools, through email, or by mail at Pleasantville Benefit Trust, PO Box 42, Pleasantville, NY 10570
Click “Contact Us” for info.
Q: How do I add an eligible person to my plan after it is in effect?
A: Any life changes like a birth, death, marriage, divorce, or adoption, etc. must be reported to the trust within 30 days of the qualifying event, otherwise, members will have to wait until December, during the open enrollment period to make any additions/deletions to their plans.
Q: If the school district is aware of a change in my life situation, can that count as notification?
A: No. Notifying the district is not the same as notifying the trust.
Q: Can I visit a non-network dentist?
A: The Delta Dental PPO program allows you the freedom to visit any licensed dentist. If you visit a non-network dentist, Delta Dental will send the benefit payment directly to you. You are responsible for paying the non-network dentist’s total fee, which may include amounts in excess of your share of your plan’s contract allowance.
Q: What does it mean to only be charged the patient’s share at the time of visiting a PPO dentist?
A: Patient’s share is the coinsurance/copayment, any remaining deductible, any amount over the annual maximum, and any services your plan does not cover.
When you visit a PPO dentist you are charged only the patient’s share at the time of treatment, Delta Dental pays its portion directly to the dentist. PPO dentists will complete claim forms and submit them for you at no charge.
Q: Do I need to file a dental claim?
A: Delta Dental dentists will handle all claims and paperwork for you. However, if you visit a non-Delta Dental dentist, you may need to file the claim yourself.
Q: Can I choose a non-network eye care provider?
A: Yes. With VSP Vision Benefits you have open access to see any eye care provider.
Q: Do I need to file a claim for covered eye care?
A: There are no claim forms to complete when you see a VSP network doctor. If you choose to see an out-of-network provider, you will need to submit a claim to VSP for reimbursement.
Q: Are my children over 18 eligible for coverage?
A: Dependents over 18 are covered. Delta terminates on the day before their 26th birthday. Vision terminates the end of the month in which they turn age 26.
Q: Is my domestic partner eligible for benefits?
A: A domestic partnership affidavit must be submitted to the district office. They will notify us if the domestic partnership is valid. You must notify us separately if you would like your partner added to your plans. You have 30 days from the qualifying event. If you fail to do so within that time period, you must wait until open enrollment.
Q: Is COBRA available?
A: Cobra is only available for Delta Dental benefits. COBRA is not offered for VSP Vision Plan.
Q: Is disability coverage offered?
A: Long-term disability insurance is provided by Unum Provident and can pay a monthly benefit if a covered disability keeps you away from work for an extended period of time.
Policy last updated: July 14, 2016
We are committed to ensuring your privacy and confidentiality as required by law. The personal information we collect is not disclosed to other companies for marketing purposes, and it is only released as necessary to administer your dental or vision benefits
The information we collect is limited to the following:
The only personal information our enrollees can maintain and change on our Web site is email address and password; all other personal information must be changed through the enrollment process administered by the trust via the website. If we do receive other personal information via our Web site or email, we retain it only for the purposes of responding to an inquiry
To protect the personal information of our enrollees, we employ industry-standard technical mechanisms, such as firewalls and encryption. We also provide secure online forms that enrollees can use for inquiries about benefits and eligibility. We advise that enrollees never disclose personal information through email, as it may not be secure.
All online services can only be accessed using a personal login ID and password. These are internally validated to make sure only those with proper authority and security authentication can view them. All pages displaying dental benefits and/or claims information are secured through encryption.
We understand that many people are sensitive about sharing their Social Security number. We only use this number to administer dental, vision benefits and long term disability insurance. It is never released to unauthorized individuals. We comply with all applicable laws relating to use and display of Social Security numbers.
This Web Privacy Policy may change. We suggest you check here periodically for updates.
This notice is required by law to tell you how Delta Dental, VSP and Unum and its affiliates protect the confidentiality of your health care information in our possession. Protected Health Information (PHI) is defined as any individually identifiable information regarding a patient’s healthcare history; mental or physical condition; or treatment. Some examples of PHI include your name, address, telephone and/or fax number, electronic mail address, social security number or other identification number, date of birth, date of treatment, treatment records, x-rays, enrollment and claims records. Delta Dental, VSP and Unum receives, uses and discloses your PHI to administer your benefit plan or as permitted or required by law. Any other disclosure of your PHI without your authorization is prohibited.
We must follow the privacy practices that are described in this notice, but also comply with any stricter requirements under federal or state law that may apply to our administration of your benefits. However, we may change this notice and make the new notice effective for all of your PHI that we maintain. If we make any substantive changes to our privacy practices, we will promptly change this notice and redistribute to you within 60 days of the change to our practices. You may also request a copy of this notice anytime by contacting the address or phone number at the end of this notice. You should receive a copy of this notice at the time of enrollment in our trust, and we will notify you of how you can receive a copy of this notice every three years.
We are permitted to use or disclose your PHI without your prior authorization for the following purposes. These permitted uses and/or disclosures include disclosures to you, uses and/or disclosures for purposes of health care treatment, payment of claims, billing of premiums, and other health care operations. If your benefit plan is sponsored by your employer or another party, we may provide PHI to your employer or that sponsor for purposes of administering your benefits. We may disclose PHI to third parties that perform services for Delta Dental in the administration of your benefits. These parties are required by law to sign a contract agreeing to protect the confidentiality of your PHI. Your PHI may be disclosed to an affiliate that performs services for Delta Dental, VSP and Unum in the administration of your benefits. These affiliates have implemented privacy policies and procedures and comply with applicable federal and state law.
We are also permitted to use and/or disclose your PHI to comply with a valid authorization, to notify or assist in notifying a family member, another person, or a personal representative of your condition, to assist in disaster relief efforts, and to report victims of abuse, neglect, or domestic violence. Other permitted uses and/or disclosures are for purposes of health oversight by government agencies, judicial, administrative, or other law enforcement purposes, information about decedents to coroners, medical examiners and funeral directors, for research purposes, for organ donation purposes, to avert a serious threat to health or safety, for specialized government functions such as military and veterans activities, for workers compensation purposes, and for use in creating summary information that can no longer be traced to you. Additionally, with certain restrictions, we are permitted to use and/or disclose your PHI for underwriting. We are also permitted to incidentally use and/or disclose your PHI during the course of a permitted use and/or disclosure, but we must attempt to keep incidental uses and/or disclosures to a minimum. We use administrative, technical, and physical safeguards to maintain the privacy of your PHI, and we must limit the use and/or disclosure of your PHI to the minimum amount necessary to accomplish the purpose of the use and/or disclosure.
Such activities may include but are not limited to: processing your claims, collecting enrollment information and premiums, reviewing the quality of health care you receive, providing customer service, resolving your grievances, and sharing payment information with other insurers. Additional examples include the following.
For example, Delta Dental, VSP and Unum may use or disclose your PHI to determine eligibility for services requested by your provider.
For example, Delta Dental, VSP or Unum may use and disclose your PHI to bill you or your plan sponsor.
For example, Delta Dental, VSP or Unum may use and disclose your PHI to review the quality of care provided by our network of providers.
We are required to disclose your PHI to you or your authorized personal representative (with certain exceptions), when required by the U. S. Secretary of Health and Human Services to investigate or determine our compliance with law, and when otherwise required by law. Delta Dental may disclose your PHI without your prior authorization in response to the following:
Delta Dental, VSP and Unum will not use or disclose your PHI without your prior authorization if the law requires your authorization. You can later revoke that authorization in writing to stop any future use and disclosure. The authorization will be obtained from you by Delta Dental or by a person requesting your PHI from Delta Dental.
You have the right to request an inspection of and obtain a copy of your PHI. You may access your PHI by contacting the appropriate Delta Dental or VSP office. You must include (1) your name, address, telephone number and identification number and (2) the PHI you are requesting. Delta Dental and/or VSP may charge a reasonable fee for providing you copies of your PHI. Delta Dental and VSP will only maintain that PHI that we obtain or utilize in providing your health care benefits.
You may not inspect or copy PHI compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, or PHI that is otherwise not subject to disclosure under federal or state law. In some circumstances, you may have a right to have this decision reviewed. Please contact the privacy office as noted below if you have questions about access to your PHI.
You have the right to request a restriction of your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.
You have the right to correct or update your PHI. This means that you may request an amendment of PHI about you for as long as we maintain this information. In certain cases we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. If your PHI was sent to us by another, we may refer you to that person to amend your PHI. For example, we may refer you to your dentist to amend your treatment chart or to your employer, if applicable, to amend your enrollment information. Please contact the privacy office as noted below if you have questions about amending your PHI.
You have the right to request or receive confidential communications from us by alternative means or at a different address. We will agree to a reasonable request if you tell us that disclosure of your PHI could endanger you. You may be required to provide us with a statement of possible danger, a different address, another method of contact or information as to how payment will be handled. Please make this request in writing to the privacy office as noted below.
You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right does not apply to disclosures for purposes of treatment, payment, or health care operations or for information we disclosed after we received a valid authorization from you. Additionally, we do not need to account for disclosures made to you, to family members or friends involved in your care, or for notification purposes. We do not need to account for disclosures made for national security reasons or certain law enforcement purposes, disclosures made as part of a limited data set, incidental disclosures, or disclosures made prior to April 14, 2003. Please contact the privacy office as noted below if you would like to receive an accounting of disclosures or if you have questions about this right.