Active and Retired Managers are Covered by the Management Benefits Fund (MBF).
MBF was established on July 1, 1967, and is managed by The Office of Labor Relations (OLR) to provide supplemental benefits to the non-unionized personnel of the City of New York, which includes all managerial, confidential, and original jurisdiction employees and retirees. The Fund receives on behalf of its members, as do the municipal labor unions, an annual contribution from the City for the provision of these ancillary employee benefits.
Since the MEA receives many calls about the fund benefits, we are providing a Q and A on the most frequently asked questions as well as appropriate links.
What is the Super Imposed Major Medical Plan?
The Superimposed Major Medical Plan (SMMP) is a supplemental (last payer type) medical coverage plan. It supplements your health insurance by providing coverage for those members and covered dependents who have qualifying out-of-pocket medical expenses, which remain after all other health coverages have been applied. This means you can get reimbursed for some of your expenses that were not already covered by insurance. See this link for further details.
How do I access this benefit? What documentation is required?
Out-of-pocket covered medical expenses should be submitted as they are incurred. In order to be considered for payment, claims must be submitted within 24 months from the dates of service. Remember, out-of-pocket expenses are those expenses you pay after your insurance coverage has paid on the claim. It may be your money, but you need to be proactive to receive it by submitting a claim.
You must submit copies of the Explanation of Benefits (EOB) from your primary health plan. This should indicate the diagnosis and CPT procedure code so that all services are properly identified. In addition, you need to submit co-payment receipts, prescription receipts. You then submit all of the documentation to the MBF on the SMMP Claim Form. See this link for further details.
As noted above, there are many benefits available of special interest to members. This includes, but is not limited to, dental coverage, vision, and hearing aids.
Other important information from the MBF website:
1) All claims are subject to review for medical necessity and appropriateness.
2) This plan does not cover services provided by an Out-of-Network Provider, if you or your eligible dependents are covered under a Health Maintenance Organization (HMO) plan.
3) This plan does not cover services where the primary plan of coverage provides a benefit for services through a network of participating providers only.
4) This plan does not cover long term care for which medical services given to a person are primarily custodial care or to aid in daily living.
5) This plan is not a basic (primary) health plan.
6) This plan does not provide coverage for prescription drugs for retired members, their spouses and/or other dependents, who are eligible to receive prescription drug coverage through a Medicare Part D plan. However, this plan will provide reimbursement, subject to the deductible requirement, for Medicare-eligible members and/or their Medicare-eligible spouse/domestic partner for the 5% out-of-pocket co-insurance incurred once the person reaches the catastrophic level of coverage under Medicare Part D. Please refer to page E.11 for additional information.
BENEFIT PAYMENT/CO-INSURANCE
Once you have satisfied your annual deductible, benefits are reimbursed at 90% of the Reasonable and Customary (R&C) allowance for medical services after benefit payments from all other health plans have been applied. Out-of pocket costs for prescription drugs are reimbursed at 80%.
The remaining 10% of the R&C allowance for medical services (or 20% for prescription drugs) is accumulated towards your out-of-pocket maximum. You are responsible for paying any charges in excess of the R&C allowance. The R&C allowance is the amount paid for medical services in a geographic area based on what providers in the area usually charge for the same or similar medical services/supplies.
Members should view the video to familiarize themselves with the range of benefits on the OLR website and familiarize themselves on the MBF booklet. These include:
- Basic Life Insurance and Group Universal Life Insurance
- Long Term Disability Insurance
- Super Imposed Major Medical Plan (SMMP) Benefits
- Dental Benefits
- Vision Care Benefits
- Survivor Benefits
- Retiree Medicare HMO Drug Benefits
- Health Club Reimbursement Program
- Consolidate Omnibus Budget Reconciliation Act (COBRA)
- Family and Medical Leave Act (FMLA)
- Special Leave of Absence Coverage
- GHI Senior Care and Medicare Supplement Health Plan Rider Subsidy Benefit