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The Management Benefits Fund
Superimposed Major Medical Plan
The Management Benefits Fund is pleased to offer supplemental (last-payer type) medical coverage to its members through its Superimposed Major Medical Plan (SMMP).
This plan supplements primary health insurance coverage by providing additional coverage to members who incur substantial qualifying 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.
Summary of Benefits and Coverage (SBC)
Notice of Grandfathered Status
Learn more about Basic City Health Insurance
Please note that members 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 Reimbursable Benefits
Hearing Aid And Audiometric Exam Benefits
The SMMP 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. These benefits are not subject to the deductible.
Family Building Benefit
Effective November 1, 2024, the Management Benefits Fund is providing a family building benefit reimbursement to MBF members under the Superimposed Major Medical Program (SMMP), for the following family building expenses up to a maximum of $10,000 per child/attempt to conceive or adopt:
- Adoption expenses,
- Surrogacy arrangement expenses, and
- Purchase of donor material.
To be eligible for this benefit, you must be enrolled in MBF and expenses must be incurred on or after November 1, 2024.
Adult Wellness Benefit
The Adult Wellness Benefit 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).
Please refer to the Fund Booklet for complete details on the Superimposed Major Medical Plan.