The Catastrophe Major Medical Plan, 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 out-of-pocket 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 -- This coverage is 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
- Critical Illness benefit (effective January 1, 2023) -- This benefit provides a one-time lump sum payment of $1,000 to help cover the costs of increased medical care.
Note: This coverage is not long-term care or nursing home insurance.
PLAN ADMINISTRATION:
Association Member Benefits Advisors (AMBA) (formerly Mercer Consumer) is the Administrator responsible for enrollment/eligibility and premium collection. AMBA 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 AMBA website or contact AMBA toll-free at 888-386-9788 if you have any questions and/or to obtain a claim form. AMBA's hours are weekdays from 9 a.m. to 7 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 if you have any questions and/or to obtain a claim form. HealthSmart’s hours are Monday through Friday from 8 a.m. to 5 p.m. (EST).
HOW TO ENROLL IN THE CMM PLAN:
The CMM Plan is currently closed to new enrollments. However, an open enrollment period may be offered from time to time. Please check back to this website for updates.
Current CMM participants can 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 AMBA toll-free at 888-386-9788.
MORE INFORMATION:
To view the 2023 Summary of Benefits & Coverage (SBC) and CMM Plan Highlights, visit the HealthSmart website at healthsmart.com/nysut. Then, click on "Forms and Documents" in the menu at the top of the page and scroll down to "Documents." 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 CMM 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).
Click here to read about recent group health plan compliance regulations and the CMM Plan's position on their applicability to the Plan.
NYSUT Associate Members and NYSUT Student Members are not eligible to enroll in this program.