Frequently Asked Questions (FAQ)
How to |
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File a Claim Online (not available for critical illness claims) |
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Read an EOB |
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Understand your benefits |
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Access EOBs |
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Check Claim Status |
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Should I have an ID Card for my CMM Plan coverage?
The CMM Plan doesn’t issue ID cards. It’s a reimbursement plan. However, you can find your ID # on your NYSUT Membership card.
What order does the CMM Plan pay when Other Insurance is applicable?
CMM would be the payor of last resort in most instances. The exceptions are when a participant, in addition to being enrolled in a Basic Plan, is enrolled in Medicaid, a State Children’s Health Insurance Program (CHIP) or TRICARE. In these scenarios, CMM is secondary to the Basic Plan, but pays before Medicaid, CHIP or TRICARE. See the Plan Document for the definition of a Basic Plan and for coordination of benefit rules.
Do I have to include the list of all my insurance plans even if I don’t plan on filing claims with them?
Yes. The CMM Plan requires copies of all Explanation of Benefits (EOBs) from all other primary insurance plans indicating they have considered the charges for payment.
What is proof of payment?
- Copy of cancelled check
- Credit card or bank statement showing payment
- Receipt from provider of service showing payment
Does the out-of-pocket deductible include the charges or any payments made by the primary insurance?
No. The CMM Plan will only consider the participant’s responsibility after all insurance coverages have considered the charges for payment.
How can I obtain access regarding my family member’s information? How can I have access to Protected Health Information (PHI)?
An Authorization for Release is required to obtain access to a family member’s Protected Health Information (PHI). The Authorization to Release form is available on the website on the Forms and Documents page. An Authorization to Release is still needed regardless of having Power of Attorney (POA).
When should I submit my Home Health Care or Assisted Living claim for payment?
Claims should be filed following the month the services have been rendered.
What documentation is needed for Home Health Care (HHC), Assisted Living Facility, Convalescent and Custodial Care Facility Benefits?
- The Home Health Care Questionnaire
- The Facility Questionnaire
- The Attending Physician Questionnaire
- Invoices from provider of service
The questionnaire forms are located on the Forms and Documents tab of this website.