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Catastrophe Major Medical

The Catastrophe Major Medical Plan, which is sponsored by the NYSUT Member Benefits Catastrophe Major Medical (CMM) Insurance Trust, is coverage that supplements a basic health plan. Regardless of your age or the type of basic health insurance you have, you and your family members could still be left with extraordinary out-of-pocket medical expenses -- especially if you have a serious medical issue, are confined to a convalescent or custodial care facility, or need home health care.

Once the deductible is satisfied, this plan provides benefits for eligible expenses that your basic plan may not fully cover. Coverage includes but is not limited to:

  • Supplemental medical insurance coverage designed to help pick up the expenses not fully covered by your basic major medical, prescription drug or hospitalization insurance, including Medicare
  • Limited nursing/convalescent home benefits up to $72 per day -- $80,000 lifetime maximum benefit
  • Home health care benefits up to 25 hours per week -- 6,000 hour lifetime maximum benefit
Please note that this coverage is not long-term care or nursing home insurance.



Plan Administration
Mercer Consumer is the Administrator responsible for enrollment/eligibility, customer service and premium collection. Mercer is also responsible for claims processing and coordination of appeals for benefit period effective dates prior to January 1, 2018.

Visit the Mercer Consumer website at nysutmbteinsurance.com or contact them toll-free at 888-386-9788 to ask questions and/or obtain a claim form. Mercer’s customer service hours are weekdays from 9 a.m. to 9 p.m. or Saturdays from 9 a.m. to 2 p.m. (EST).

We’re pleased to announce that HealthSmart Benefit Solutions, Inc. serves as the new Administrator responsible for claims processing and coordination of appeals for benefit period effective dates of January 1, 2018 and beyond.

Visit the HealthSmart website at healthsmart.com/nysut or contact them toll-free at 844-552-7805 to ask questions and/or obtain a claim form. HealthSmart’s customer service hours are Monday through Friday from 8 a.m. to 5 p.m. (EST).

Plan Changes
The current CMM Plan underwent significant benefit changes, effective January 1, 2018. Participants received a CMM Plan Document in January 2018 that fully described the new Plan. You can also view an overview of the new Plan by reviewing the 2018 CMM Plan Highlights and 2018 Summary of Benefits & Coverage (SBC). Both are available at HealthSmart’s website at healthsmart.com/nysut or by contacting them toll-free at 844-552-7805.



How Can I Enroll in the CMM Plan?
NYSUT members cannot currently enroll in the CMM Plan. However, an open enrollment period may be offered from time to time. The most recent open enrollment period was from May 1, 2017 to June 15, 2017. Please visit the Member Benefits website periodically for updates.

Current CMM participants have the ability to add dependents through a “life event” process outlined in the CMM Plan Document. Newly acquired dependents can be added within 60 days of the “life event.” For details, contact Mercer Consumer toll-free at 888-386-9788.


Further Information
With regard to how your medical information may be used and disclosed, as well as how you can access this information, please refer to the NYSUT Member Benefits Catastrophe Major Medical Insurance Trust’s Notice of Privacy Practices. If you would like a copy of this notice mailed to you free of charge, contact Member Benefits at 800-626-8101, weekdays from 9 a.m. to 5 p.m. (EST).

To view the current CMM Plan's Summary of Benefits & Coverage for 2017, visit the Mercer Consumer website at nysutmbteinsurance.com. The SBC is also available free of charge by contacting Mercer Consumer.