Group Catastrophe Major Medical Insurance Plan

What It Is
Eligibility
Features
Plan Options
Obtain A Quote
Implement A Plan

What It Is

The NYSUT Member Benefits Trust-endorsed Group Catastrophe Major Medical Insurance Plan is only available for purchase by local associations, their benefit funds, and employers. The Group Plan supplements basic hospitalization and major medical insurance coverage, including Medicare and long-term care insurance. It is required that the basic medical policy have a lifetime maximum benefit of at least $500,000 per insured. The plan’s benefits include nursing/convalescent home care, home health care, private duty nursing, ambulance service and medical equipment.

Each person covered by the group plan has a $25,000 deductible and 3 years in which to satisfy that deductible. Out-of-pocket expenses, as well as those eligible expenses paid by a participant’s basic health insurance, apply to the deductible.

Once the deductible is met, the plan provides up to 100% coverage for the reasonable and customary eligible expenses that exceed a participant’s base coverage. The plan may pay up to $2 million in benefits for up to 5 years from the date the first eligible expense applied to the deductible is incurred.

The NYSUT Member Benefits Trust-endorsed Group 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 Group 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 this 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.

Eligibility

The NYSUT Member Benefits Trust-endorsed Group Catastrophe Major Medical Insurance Plan is only available for purchase by local associations, their benefit funds, and employers.

Catastrophe Major Medical coverage is automatic for each individual in your group. Coverage can also be extended to spouses or domestic partners and dependent children (to age 21 or to age 27 if a full-time student).

There is no individual underwriting for participants to be covered under the Group Catastrophe Major Medical Plan. However, the plan's pre-existing condition rules do apply with regard to benefit eligibility.

Features

The waiver of individual underwriting is of benefit to those who could be denied coverage under the voluntary Catastrophe Plan because of the underwriting process.

If a covered participant is confined to a nursing/convalescent home, the plan pays for covered expenses up to $500 per week for up to 3 years (lifetime maximum of $80,000). Pre-hospitalization is not required, and benefits begin on the 6th day of confinement.

Up to 300 visits per calendar year are covered for part-time or intermittent home health care aide services (4 hours per visit), physical therapy, occupational therapy or speech therapy.

For private duty nursing services in a hospital or at home, the plan pays 85% of usual and customary charges, $120 maximum per 8-hour shift (lifetime maximum of $35,000).

Any form of ambulance service to and from any hospital for treatment prescribed by a licensed physician is covered ($2,000 lifetime maximum).

The plan covers rental of: mechanical equipment used to treat respiratory paralysis; oxygen and the equipment to administer it; other medical equipment such as wheelchairs or hospital beds.

Each participant receives an individual certificate of coverage.

The Group Plan provides a critical illness benefit of $2,500. This one-time benefit is payable if a covered participant is diagnosed with a critical illness after the Group Plan is in place. Critical illness is defined in the certificate of insurance. In addition, the Health Advocate medical assistance program is provided free of charge for one year to individuals eligible for the critical illness.

Plan Options

Standard plan available. No customization available at this time.

Obtain A Quote

Your total group premium is determined by every participant to be covered. Once the aggregate premium is determined, this amount is discounted. To obtain a Group Catastrophe Major Medical quote, you must provide the sex and date of birth of each individual to be covered.

For more information, please contact Member Benefits toll-free at (800) 626-8101, weekdays from 9 a.m. to 5 p.m. Eastern Time.

The NYSUT Member Benefits Trust-endorsed Group Catastrophe Major Medical Plan is provided by United States Life Insurance Company (USLIFE) and administered by Marsh Affinity Group Services.

Implement A Plan

Once the decision has been made to purchase the NYSUT Member Benefits Trust-endorsed Catastrophe Major Medical Insurance Plan on a group basis, here’s what needs to be done to implement this plan:

Provide contact name/address/phone number.
List of all participants (Participant name, Social Security number, Date Of Birth, home address. If group is covering dependents, dependent name(s) & DOB are also required.).
Upon receipt of eligibility information, billings will be sent to group contact by plan administrator.
Individual Certificates of Insurance are mailed to participants.
Membership presentation announcing plan.