VSTA Welfare Fund

The Valley Stream Teachers’ Association Welfare Fund was established in 1976 as a result of negotiations between the Valley Stream Teachers’ Association and the four Valley Stream Boards of Education for the purpose of providing dental insurance for the majority of the staff of the four districts. As the years went on, excess major medical insurance and vision care coverage were also offered.

The Welfare Fund consists of five trustees, elected to three year terms by the VSTA Executive Council, who oversee the operation of the Fund. The trustees meet several times throughout the year. They retain the services of a Director, who is responsible for the day-to-day operation of the Fund, along with all record keeping and financial transactions.

Through collective bargaining, a specific sum of money is paid by the four districts to the Welfare Fund each month to defray the cost of the insurance premiums. br>
Children are eligible to be a dependent under your coverage if either:

1) they are under 19 years of age; or

2) they are a full-time college student. Full-time status is defined as enrolled in 12 credits per semester, with one exception. A graduate student taking 6 or more credits in their FINAL semester will be granted full-time status and retain eligibility as a dependent. Please note that in that case, the proof of enrollment MUST indicate that the expected date of graduation is at the end of that semester.Their coverage will terminate either on their 25th birthday or at the end of the month in their which college enrollment ends, whichever comes first. (For example, if the dependent’s 25th birthday is on March 8th, they will be covered through March 7th, even if they are still enrolled as a full-time student. However, for a full-time student under the age of 25, if their last day of college enrollment is on May 5th, they will be covered through May 31st); or

3) they are mentally ill, developmentally disabled, mentally retarded or have a physical handicap. Contact the Welfare Fund within thirty-one days of the date your child’s coverage would normally end for details and forms.

Please note that the dependent rules for medical insurance may differ.

Our dental insurance plan is self-funded by the Welfare Fund, with J.J. Stanis & Co. our plan administrator, processing our claims and paying claimants with monies from the Fund’s account. Our excess major medical insurance and vision care coverages are provided through policies from the ShelterPoint Life Insurance Company (formerly known as First Rehabilitation Insurance Company), with J.J. Stanis & Co. as our agent.

Every participant is enrolled in one of two Vision plans that we offer. One policy was designed and negotiated by New York State for employees enrolled in the New York State Empire Medical Plan or in an approved similar plan. This policy includes an Excess Major Medical Insurance rider. The other policy, for those employees without New York State Empire Medical Insurance, only covers Vision benefits, but now includes NVA as a preferred provider. If you are enrolled in Empire through Valley Stream, you are automatically enrolled in the Vision plan with Excess Major Medical Insurance. If you do NOT have Empire through Valley Stream, but are enrolled in the New York State Empire Medical program through your spouse or are enrolled in an approved similar plan, you are eligible to be enrolled in our Excess Major Medical Policy.

There are several important issues that you must be aware of:

1) If you are enrolled in the New York State Empire Medical program through your spouse working in another school district/governmental agency, YOU must notify the Welfare Fund to inform us of that fact, as your school district will be unaware of that enrollment. After receiving that information, you can be enrolled in the Vision program with the Excess Major Medical Insurance rider.

2) If you are enrolled in the New York State Empire Medical program with Individual Coverage, but have a Family enrollment with the Welfare Fund, your dependents WILL be enrolled in our dental program, but WILL NOT be enrolled in the Excess Major Medical plan.This is not the case if you are enrolled in the Vision only plan.

3) If you were previously enrolled in the New York State Empire Medical program, but either transferred your Empire medical coverage to a Non-Empire plan or dropped medical coverage entirely, you should have completed a new Welfare Fund enrollment form to notify us of that fact, so that you could be transferred to our other Vision plan. If you did not inform us of the change and received benefits from the incorrect policy, there is a possibility that the insurance company, ShelterPoint Life Insurance Company, could request a return of any benefit payment.

All dental, vision and excess major medical insurance inquiries regarding enrollment, coverage and claims issues should be directed towards the offices of J.J. Stanis & Co. at 516-465-3900 or toll-free at 1-877-470-3715 from 8:30 AM until 5:00 PM, Monday through Friday. Additional information may be found on J.J. Stanis & Co.’s website: WWW.JJSTANISCO.COM

Claims may be submitted using any of the following methods:
1) By U.S. mail to:
J.J. Stanis and Company, Inc.
377 Oak Street - Suite 406
Garden City, NY 11530

2) Emailed to: Claims1@jjstanisco.com
3) Faxed to: 516-465-3920
4) Electronically submitted directly from your dental provider

Changes in enrollment status, name and address changes and updating dependents should be submitted to your district’s health benefits office, using our “Enrollment/Change” form available from that office or downloaded from this website.

If you have any questions or concerns, please call the VSTA office.

Policy Descriptions

Dental Insurance
Excess Major Medical/Vision (For NYSHIP Empire Enrollees ONLY)
Additional Explanation of Excess Major Medical Benefits (For NYSHIP Empire Enrollees ONLY)
Vision Insurance (For NON-Empire Enrollees)
    Benefit Summary
    Full Insurance Certificate
    NVA Member Portal Instructions

Forms

Enrollment/Change Form
Dental Claim Form
Vision Claim Form
Excess Major Medical (Co-Insurance Claims)
Excess Major Medical (In-Hospital Claims)

Miscellaneous Information

HIPAA Privacy Notice
Annual Financial Statement