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.