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Catastrophe Major Insurance

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. This is especially true if you have a serious medical issue, are confined to a nursing home/convalescent 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 with 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: This coverage is not long-term care or nursing home insurance.

How Can I 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 May 1-June 15, 2017. Please check back at this website for updates.

Current CMM participants have the ability to add dependents through a "life event" process which is outlined in the CMM Plan Document. Newly acquired dependents can be added within 60 days of the "life event." Contact us for details.

Attention current CMM participants - It is important to note that the current CMM Plan will be undergoing significant benefit changes effective January 1, 2018. Participants will be sent a new CMM Plan Document in January 2018 that will fully describe the new Plan. In the meantime, download the “2018 CMM Plan Highlights” for more information.

Discounted Rates for Payroll or Pension Deduction – If you belong to a local association that has made arrangements for payroll deduction of NYSUT Member Benefits endorsed/sponsored programs or if you are receiving a monthly pension benefit from NYSTRS, NYCTRS, or NYSERS, NYCBERS, or a monthly lifetime annuity payment from TIAA-CREF, you should consider taking advantage of this easy, convenient payment method. By doing so, you will save 10 percent on your premiums.

If NYSUT Member Benefits payroll or pension deduction is not available to you, the other payment options are:

  • Individual billing on a semiannual basis.
  • Monthly re-occurring payments deducted from your checking account.
  • Monthly re-occurring payments deducted from your credit card.

How Do I File A Claim?

Refer to the Claims Tab on this page for details.

 

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:

Voluntary Catastrophe Major Medical Plan – Claim Form for Benefit Periods Prior to 1/1/18

Group Catastrophe Major Medical Plan – Claim Form for Benefit Periods Prior to 1/1/18

Group Catastrophe Major Medical Plan – Critical Illness Form for Benefit Periods Prior to 1/1/18

CMM Plan – Claim Reference Guide for Benefit Periods Prior to 1/1/18

The Claim Administrator for benefit period effective dates prior to 1/1/18 is:
Mercer Consumer
Phone: 1-888-386-9788
9 a.m. to 9 p.m. Eastern, Monday-Friday and
9 a.m. to 6 p.m. Eastern, Saturday and Sunday

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 period effective dates of 1/1/18 or beyond is:
HealthSmart Benefit Solutions
Phone: 1-844-552-7805
8 a.m. to 5 p.m. Eastern, Monday-Friday
healthsmart.com/nysut

We're here to help! Please contact us in whatever manner is most convenient for you.

Program Administrator

Mercer Consumer
PO Box 9186
Des Moines, IA 50306-9186

Phone: 1-888-386-9788

9 a.m. to 9 p.m. Eastern, Monday-Friday and
9 a.m. to 6 p.m. Eastern, Saturday and Sunday

email: customerservice.service@mercer.com

Claims

Please refer to the Claims tab on this page for claims contact information.

Our Role & Compensation

Details of Mercer disclosure of the compensation.

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