Catastrophic Major Medical Insurance Plan
NY Residents Only

How do I apply for coverage?

1. Complete and sign the enrollment form.
2. Your affordable group rates are listed on the chart (click here), but send no money now.  You will be sent a premium statement for the required premium payment
3. Mail your enrollment form to:
   
   Plan Administrator
   Columbia Alumni Association
   Group Insurance Program
   P.O. Box 152501
   Irving, TX 75015-2501

If You Have Questions...

If you have questions...or would like assistance in completing your enrollment form call toll free:

1-800-223-1147
weekdays between 8:00 a.m. and 5:00 p.m., Central Time.

Click here for the enrollment form

You will need Acrobat Reader the PDF form. If you do not have the Acrobat Reader, visit www.adobe.com to download it FREE!

Underwritten by:
The United States Life Insurance Company in the City of New York
A  member company of American International Group, Inc.

The description of benefits and provisions contained on this web site is not a contract of insurance and is subject to the terms, conditions and limitations of Group Policy No. E-125,189 Form No. G-19000 issued to the Trustee of the Group Insurance Trust.  The Certificate of Insurance issued to Insured Members provides complete coverage information regarding policy benefits, restrictions, exclusions and limitations.

Some Benefits may vary by state. Coverage is not available in all states.

This is not Medicare Supplement Insurance

This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions.  It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

• any expenses or services covered by the policy are also covered by Medicare; or
• it pays the fixed dollar amount stated in the policy and Medicare covers the same event.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them.  These include:

• hospitalization
• physician services
• hospice care
• other approved items & service

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company
• For help in understanding your health insurance, contact your state insurance department or state senior insurance counseling program.