Did you know? Superimposed Major Medical Plan (SMMP) claims and Dental Claim Documents can be filed online.
What Is It?
The Superimposed Major Medical Plan (SMMP) is a supplemental (last-payer type) medical coverage plan intended to supplement your basic City health insurance coverage by providing additional coverage when you incur substantial out-of-pocket medical expenses that remain after all other health coverage has been applied. After an individual calendar year deductible is satisfied, the plan reimburses 90%* of non-reimbursed covered medical expenses at Reasonable and Customary (R&C) allowances until out-of-pocket expenses reach $2,500.
* Reimbursement is at 80% of R&C for out-of-pocket costs incurred for prescription drugs.
Program Details
SMMP’s Summary of Benefits and Coverage (SBC)
Those covered under HMO plans are required to use the services of HMO providers and can only use the Fund’s SMMP for co-payments or services not available under their HMO plan.
SMMP also provides a hearing aid and audiometric examination benefit covering a maximum of up to $2,000 per hearing aid and 90% of Reasonable and Customary (R&C) allowances for audiometric examination. This benefit is not subject to the deductible.
Gather Documents
1. Submit medical bills to your primary health plan for benefit determination. Note: If you are a participant in the Health Benefits Buy-Out Waiver Program, you are covered for primary health benefits either under your spouse’s plan or through other current/former employment. In these cases, expenses must first be submitted to the other plans for benefit determination.
2. If you are covered under both the City’s Employee Health Benefits Program and a spouse’s plan (or a plan through other current/former employment), medical bills must be submitted to all other plans before the SMMP.
3. Compile all itemized bills generated from your health care provider related to this benefit.
4. Compile Explanation of Benefits (EOB) statements provided by all health plan(s) that correspond to the abovementioned itemized bills.
5. Include proof of payment (cancelled check, receipt, etc.) for all out-of-pocket expenses. Computer generated forms from a provider may not be acceptable.
Get Started
Create your profile, HERE.
Submitting SMMP claims
Complete the SMMP Claim Form and submit the claim form, with all documentation, including itemized bills, EOBs, and proof of payment of out-of-pocket expenses electronically by visiting and registering, HERE.
Download this section of the Fund Booklet
Still Have Questions? See the SMMP FAQs
You may still submit claims via mail at the following address:
MBF SMMP Claims
Administrative Services Only (ASO), Inc.
PO Box 9009
Lynbrook, NY 11563-9009
There is also an Adult Wellness Benefit that covers annual and/or periodic physical and screening examinations that can result in early detection and intervention before a serious disease develops or advances. Some tests are age and gender-specific or related to health risk factors. Coverage is provided up to 100% of R&C and is not subject to the deductible. The Plan is administered by Administrative Services Only, Inc. (ASO). For questions or inquiries on claims matters, a member may call ASO’s customer service department toll-free at SMMP (877-844-7667).
MEA does not administer this program.