CATASTROPHIC MEDICAL BENEFIT
Benefits
DC 37 Health & Security Plan Benefits
Catastrophic Medical Benefit (Full-time,
active employees only)
This benefit is available only to full
time active employees who are enrolled in the GHI-CBP Blue Cross program.
The
GHI-CBP program currently has a $1,500 annual catastrophic limit in the base
program for individuals who choose non-participating providers for in-hospital
or related care. Once an individual has $1,500 in covered out-of-pocket
expenses (excluding deductibles), based on usual and customary provider fees,
GHI pays 100% of the reasonable and customary charges. The in-hospital and
related services, which are applied to the catastrophic coverage
are: surgery, anesthesia, maternity care, in-hospital medical care, radiation,
chemotherapy, and expenses related to in-hospital x-ray and laboratory
services.
The catastrophic limit is lowered from $1,500 to $1,000 in covered
out-of-pocket expenses for full time active employees enrolled in the GHI-CBP
Blue Cross Program.
The
Plan must certify the eligibility of a member and eligible dependent to GHI-CBP
each calendar year in order for that individual to obtain the enhancement of
the GHI-CBP coverage described above. The certification shall be made by the
Plan in accordance with the procedures established by the Trustees. Eligibility
must be certified once each calendar year in order to receive the enhancement
of the GHI-CBP coverage described above in such calendar year.
