These plans have been designed to help you meet the cost of dental, optical care and supplement medical benefits. Since it is not intended that you receive greater benefits than the actual expenses incurred, the amount of benefits payable under this plan will take into account any coverage you, your spouse or dependents have under other group plans. That is, the benefits under this plan will be coordinated with the benefits of other group plans. In the event the patient’s basic health plan covers a benefit also provided by the Fund, then that health plan shall be deemed primary.
If your spouse or child is covered by another group coverage plan, then that plan has first responsibility for him or her and must pay all expenses incurred up to the limit of the schedules in that plan. However, if the plan covering your spouse or child does not provide enough coverage to pay all the expenses incurred, this Fund will pay the uncovered expenses within the limits of our own schedules. In other words, you cannot collect full coverage under your spouse’s plan and then collect the same full coverage from this Fund if that total amount exceeded the actual expenses incurred.
Where the husband and wife are both covered under separate plans the first application for benefits should be made to the group coverage plan which has first responsibility. Therefore, the spouse of a member should apply to his or her own plan first. Also, the group coverage plan which has primary responsibility for dependent children should be submitted to first. If that plan does not cover all the expenses incurred, then our member should apply to us for benefits to cover the difference.
Submit the claim to the plan of the parent whose birthday (month and day only) occurs first in a calendar year.
If the stepchild of a member is granted coverage under the Fund for any benefits, this Fund will be considered responsible only after exhausting any benefits either of the natural parents may have.
Where husband and wife are both covered by the Suffolk County Superior Officers Association Benefit Fund, benefits will be provided in accordance with the provisions of Coordination with other plans as described above.
If you have any doubt about coverage for you, your spouse and your dependent children, please get in touch with the Fund office. We will be glad to answer any questions and to make sure that you receive all benefits to which you are entitled.
Coordination with PBA Benefit Fund
When a member is promoted to Sergeant, any benefits he/she and his/her dependents received as a P.B.A. Benefit Fund member will be coordinated with any benefits he/she will be receiving as an S.O.A. Benefit Fund member. This also applies to all annual & lifetime limitations. Example: If a member utilized his/her optical service from the P.B.A. Benefit Fund before his/her promotion to Sergeant, he/she must wait 12 months from that date of service to be eligible for the optical benefit from this Fund