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.

This is especially true 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 not fully covered.

Coverage includes but is not limited to:

  • Supplemental medical insurance coverage 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
Click here to read about recent group health plan compliance regulations and the CMM Plan’s position on their applicability to the Plan.
 

Determining Your Benefit Period

January 1, 2018 or beyond

For claims filed with a benefit period effective date of January 1, 2018 or beyond, please contact HealthSmart Benefit Solutions for claims processing.

The Claim Administrator for benefit periods 1/1/18 or beyond is:

HealthSmart Benefit Solutions
Phone: 844-552-7805
8 a.m. to 5 p.m. Eastern, Monday-Friday
healthsmart.com/nysut

December 31, 2017 or before

If your benefit period effective date is December 31, 2017 or before, please contact Mercer Consumer regarding claims processing. This applies to individuals who are submitting claims under the $15,000 or $25,000 deductible CMM plans. Please refer to the following details for claims under this plan:

The Claim Administrator for benefit periods prior to 1/1/18 is:

Mercer Consumer
Phone: 888-386-9788
9 a.m. to 9 p.m. Eastern, Monday-Friday
nysutmbteinsurance.com

Determining Who To Contact

For questions about:

  • Enrollment/eligibility
  • Premium payments
  • Claims processing & coordination of appeals for benefit period effective dates prior to January 1, 2018

Please contact Mercer Consumer at:

Phone: 888-386-9788
9 a.m. to 9 p.m. Eastern, Monday-Friday

nysutmbteinsurance.com

For questions about:

  • Claims processing for benefit period effective dates January 1, 2018 or beyond

Please contact HealthSmart Benefit Solutions at:

Phone: 844-552-7805
8 a.m. to 5 p.m. Eastern, Monday-Friday

HealthSmart.com/NYSUT