DENTAL PLAN OPTIONS FOR RETIREES
(Vision Plan Benefits on Backside)
NAME OF PLANS:
COBRA
(Effective 1/1/2022)
Emblem Health Direct
Payment Plan
Sun Life Dental – made available through
PEF Retirees (Effective 1/1/2020)
PLAN ADMINISTRATOR:
NYS Civil Service
Emblem Health (formerly GHI)
Preferred Dental Plan
Emblem Health
Sun Life
Must be a current dues-paying PEF Retiree
member to participate.
WHO TO CALL:
Contact Civil Service at:
(800) 833-4344
Contact Emblem Health at:
(800) 947-0101
Contact Sun Life at:
(844) 738-8118, Group #: 935636
PLAN FEATURES:
100% Prosthetic coverage, plus all
basic dental services.
80% Prosthetic coverage, plus all
basic dental services.
Single Level Plan Coverage:
Preventive Services (Type I): 100%
Restorative Services (Type II: 80%
Major Restorative Services (Type III): 50%
MONTHLY PLAN PREMIUMS:
$22.78 – (Individual)
$66.30 – (family)
$35.54 – (individual)
$66.90 – (individual & spouse)
$99.19 – (family)
$49.82
–
(individual)
$84.72 – (individual & spouse)
$129.31 – (family)
Purchase of the Sun Life Dental Plan provides
access to a NO COST vision discount plan through
Vision Service Plan. Get discounts on eye exams &
eyewear.
ENROLLMENT QUALIFICATIONS/PROCESS:
You must enroll no later than 60
days from the end of active
employee coverage. During the
28-day grace period following
retirement, Civil Service will
automatically mail you the COBRA
option. You must apply within 60
days post retirement.
You must enroll no later than 90
days post retirement, OR
immediately following the end of
COBRA coverage. You should
automatically receive an
enrollment form and summary of
benefits after you retire, or at the
end of the COBRA period. If you
do not, call (800) 947-0101.
Enrollment is continuous for this benefit.
You must be a current dues-paying PEF Retiree
member to be eligible to join the NYS PEF Retirees
Dental Program. If you terminate your dental
coverage after your initial enrollment, you cannot
re-enroll later. However, if you previously
terminated your coverage and you also have a
Qualified Status Change (e.g., loss of coverage),
you may re-enroll if you do so within 120 days of
the date of your Qualified Status Change.
LENGTH/TERM OF COVERAGE:
Please contact Civil Service for
plan coverage details.
No limit.
No limit.
ANNUAL DEDUCTIBLE:
$25
$25
$25—self; $50—self & dependent; $75—family
ANNUAL MAXIMUM:
$2,300
$1,800
$1,500 (Preventative services are not counted
toward the $1,500 calendar year maximum—
leaving more coverage for more expensive
procedures.)
DENTAL & VISION
PLAN BENEFITS FOR
NYS RETIREES
VISION PLAN OPTIONS:
COBRA (Effective 1.1.2022)
SOURCE/PROVIDER:
NYS Vision Care Plan
CONTACT:
NYS Department of Civil Service: (800) 833-4344
ENROLLMENT:
You must enroll no later than 60 days from end of active employment coverage.
LENGTH OF COVERAGE:
Please contact Civil Service for plan coverage details.
MONTHLY PREMIUM:
$4.46 – (individual)
$10.35 – (family)
For more information on Cobra and continuation of vision benefits, visit NYShip Online:
cs.ny.gov/employee-benefits/login/index-retiree.cfm.
DAVIS VISION (Plan Year from November 1, 2021 through October 31, 2022)
SOURCE/PROVIDER:
PEF Retirees/Davis Vision (You must be a current, dues-paying member of PEF Retirees to take advantage of this benefit.)
PLAN DETAILS:
Visit pefmbp.com/insurance/retiree-vision-plan, to learn about the plan, as well as the discounts and savings offers on
products and services.
TO PURCHASE THE PLAN:
Visit pefmbp.com/insurance/retiree-vision-plan to purchase the discount plan inclusive of an annual eye exam, free frames,
fixed lens pricing, and more for the period of November 1, 2021 through October 31, 2022. Or, call the PEF Membership
Benefits Program at (800) 342-4306, ext. 243.
TO CONFIRM THE PLAN (after purchase):
Three (3) business days after you purchase the plan, contact Davis Vision Customer Service at (844) 681-4498 and reference
Client Code: 2395. You will need to provide Davis Vision with your MIN and date of birth for a spouse or family members if
you select coverage beyond individual coverage. Please note: This is not an insurance plan.
LENGTH OF COVERAGE:
The vision plan year begins November 1, 2021 and concludes October 31, 2022 regardless of when you purchase the plan
during this time frame. You must take advantage of the plan’s product and service offerings, by October 31, 2022. If you
purchase the plan for Nov. 1, 2021 through Oct. 31, 2022, you will receive a renewal letter from PEF Retirees a few weeks
prior to November 1, 2022, reminding you to repurchase the plan for the upcoming plan year, November 1, 2022 through
October 31, 2023, if you are interested in doing so. The plan does not auto renew. It is your choice as to whether or not you
would like to repurchase the plan for the next plan year.
NOVEMBER 1, 2021 – OCTOBER 31, 2022 PLAN
OPTIONS & PRICING:
$215.04
– (Retiree)
$367.80 – (Retiree Plus One)
$558.84 – (Retiree Plus Family)
YEARLY PAYMENT:
Payment for the Davis Vision plan is made as a single, lump sum payment. There is no monthly payment option available.
Revised 2/2022