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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 Catastrophe Major Medical page on the Mercer Consumer website or contact Mercer 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).

HealthSmart Benefit Solutions, Inc. is the 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).



HOW TO 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.



MORE INFORMATION:
To view the 2019 Summary of Benefits & Coverage (SBC) and CMM Plan Highlights, visit the HealthSmart website at healthsmart.com/nysut and then click on "How to and Questions" in the menu at the top of the page.

Both documents are also available in paper form at no charge by contacting HealthSmart toll-free at 844-552-7805.

With regards 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 at no charge, contact Member Benefits at 800-626-8101, weekdays from 9 a.m. to 5 p.m. (EST).