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Catastrophic Major Medical (Retirees)
Catastrophic major medical insurance supplements both your basic health insurance under the NYC Employee Health Benefits Program (NYC HBP) and your supplemental health insurance provided by the PSC-CUNY Welfare Fund. It is intended to provide additional financial protection in the event of a major illness or injury. You can enroll yourself, your spouse or domestic partner and your eligible dependent child(ren). The plan pays benefits when you meet a $10,000 deductible. All reasonable and customary charges, including those paid by basic health insurance, count toward the deductible. Your premiums for optional catastrophic major medical insurance will depend on your age when you first enroll and then each year when you renew your coverage. More information and an application are available here.
This page includes only highlights of optional catastrophic major medical insurance. See the Details Tab for more information.
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The Catastrophic Major Medical Insurance Plan has been designed to supplement the basic health insurance policy as well as supplemental policies provided by the PSC-CUNY Welfare Fund. Additionally, it pays in excess of Medicare Parts A & B. The plan includes a large deductible and may limit certain benefits. In addition to addressing uncovered expenses of the basic health insurance, benefits covered under this plan include: Convalescent Home Benefits, Home Health Benefits, and Private Duty Nursing Services.
Full-time or retired members, spouses and domestic partners are eligible to apply for coverage, regardless of age as long as all are covered under the NYC Health Benefits Program or Medicare (Parts A and B). An insured member's unmarried, dependent children from birth to 21 years (27 if attending school full-time) are also eligible.
There is a $10,000 deductible (or the amount paid by the health insurance if higher). When insured, reasonable and customary eligible expenses count toward meeting deductible in full. Even those eligible expenses paid for by the basic health insurance policy, as well as those paid out of own pocket, count toward the deductible.
TRS or TIAA-CREF retirees should complete the Catastrophic Major Medical Insurance Plan Application for Retired Members and return to Marsh Affinity Group Services along with the Pension Deduction Authorization.
Coverage will be effective following receipt and acceptance of the written application and applicable premium payment. Applicants must meet medical conditions of insurability.
The premium for this plan is based on age when insurance becomes effective and on attained age bracket on renewal dates. Premiums may be paid through a) pension deduction (with the Pension Deduction Authorization), b) automatic check withdrawal or c) direct billing.
An insured's benefit period begins on the date the first eligible expense is incurred and will cease at the earlier of: completion of 10 years from the day eligibility expenses were first incurred; $2,000,000 has been paid; the insured recovers; after 24 months from the date the first eligible expense is incurred if 90 consecutive days pass without at least $150 of eligible expenses being incurred; or the end of 12 consecutive months during which no charge is incurred.
Coverage continues for covered dependent spouse or domestic partner and children as long as the dependents meet eligibility requirements, premiums are paid at the adjusted rate (depending on the survivor's age) and the policy remains in force.
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