Catastrophe Major Medical
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What It Is Eligibility Features Payment Options How To Apply Contact |
What It IsCatastrophe Major Medical Insurance supplements your basic hospitalization and major medical insurance, including Medicare, as well as long-term care insurance. After the deductible has been met, the plan pays up to 100% of eligible expenses not recovered by other insurance for up to 5 years or $2 million. NYSUT Member Benefits Trust-endorsed Catastrophe Major Medical Insurance is underwritten by The United States Life Insurance Company in the City of New York and is administered by Marsh Affinity Group Services. The United States Life’s Catastrophe Major Medical Plan is a NYSUT Member Benefits Trust (Member Benefits)-endorsed program. Member Benefits has an expense reimbursement/endorsement arrangement of 2.9% of earned premiums for this program. All such payments to Member Benefits are used solely to defray the costs of administering its various programs and, where appropriate, to enhance them. The Insurer pools the premiums of Member Benefits participants who are insured for the purposes of determining premium rates and accounting. Coverage outside of tihs plan may have rates and terms that are not the same as those obtainable through Member Benefits. The Insurer or Member Benefits may hold premium reserves that may be used to offset rate increases and/or fund such other expenses related to the plan as determined appropriate by Member Benefits. Member Benefits acts as your advocate; please contact Member Benefits at (800) 626-8101 if you experience a problem with any endorsed program. Agency fee payers to NYSUT are eligible to participate in NYSUT Member Benefits Trust-endorsed programs.
EligibilityMembers and agency fee payers who are age 79 or younger, in-service or retired, are eligible to apply. Basic health insurance (or Medicare) is required, and a member may add coverage for a spouse or certified domestic partner, dependents to age 21 (27 if full-time students), parents and parents-in-law, as long as each person applying is age 79 or younger, covered under a basic medical plan and has not been treated or diagnosed in the last 5 years for a condition listed on the application.
FeaturesThe plan includes a $25,000 deductible, and you have 3 full years from the date your first eligible expense is incurred to satisfy this deductible. All reasonable and customary eligible expenses count toward your deductible, including those paid by your basic health insurance policy, as well as those you pay out of pocket. “Reasonable and customary” means the normal charge for a certain procedure or service performed by medical providers in your area. For example, if your doctor charges $3,000 for a surgical procedure, basic medical insurance allows $2,400 and you pay the $600 balance, the entire $3,000 will likely be considered reasonable and customary. If, however, your doctor charges $5,000 for a procedure for which most doctors only charge $3,000, the extra amount may not be considered reasonable and customary and therefore will not count toward your deductible.
If more than 1 insured family member is injured in the same accident or contracts the same contagious disease within 30 days, only 1 deductible needs to be satisfied, and each insured member will still be eligible for up to $2 million in benefits for up to 5 years during the benefit period.
Catastrophe Major Medical Insurance coverage continues for insured dependents of a deceased member as long as the dependents meet the normal eligibility requirements and the premiums are paid.
Payment OptionsIf payroll or pension deduction of NYSUT Member Benefits Trust is available to you and you choose to pay your premiums through this option, you save 10% on annual premiums. You can also be billed directly on a semi-annual basis.
How To ApplyYou must complete the Catastrophe Major Medical Insurance Plan application. The plan is medically underwritten. To receive a brochure and application, call the Plan Administrator, Marsh Affinity Group Services, toll-free at (888) 38-NYSUT (888-386-9788), weekdays from 9:15 a.m. to 6 p.m. Eastern Time. You can click on the Marsh Affinity link below to download a brochure and application.
ContactFor more information on eligibility, plan benefits and exclusions, billing rates or to receive an application, call the Plan Administrator toll-free at (888) 38-NYSUT (1-888-386-9788), weekdays from 9:15 a.m. to 6 p.m. Eastern Time. NYSUT Member Benefits Trust-endorsed Catastrophe Major Medical Insurance is underwritten by The United States Life Insurance Company in the City of New York and is administered by Marsh Affinity Group Services. |
