MMC Benefits Handbook
Is there a network of doctors and hospitals that I have to use?
Using the network is not mandatory, but generally, you will receive a higher reimbursement when using the network. If you use an in-network provider, you will be reimbursed 80% (70% under the $2,850 Deductible Plan). If you use an out-of-network provider, you will be reimbursed 60% (50% under the $2,850 Deductible Plan) of reasonable and customary charges for covered expenses after the Plan's deductible has been met.
In the event that you receive care from an out-of-network doctor (such as an anesthesiologist) while being treated at an in-network facility, benefits will be paid at the in-network level.
The network includes general practitioners, as well as specialists and hospitals. These network providers are selected by and contracted with the Claims Administrator.
Where can I get a directory that lists all the doctors and hospitals in the network?
The doctors and hospitals in the network are listed in a provider directory. The Claims Administrator provides an online directory of providers available at www.aetna.com. You may also call the Claims Administrator.
Is there a network of providers for mental health treatment?
There is a network of mental health providers. Providers in the network are listed in a provider directory. The Claims Administrator provides an online directory available at www.aetna.com. You may also call the Claims Administrator.
Is there a network of pharmacies?
There is a pharmacy network associated with this Plan. You must use a pharmacy in the network to receive coverage under this Plan.
The Pharmacy Benefits Manager provides an online directory of network pharmacies available at http://www.express-scripts.com/.
To locate an in-network retail pharmacy:
- Log on to express-scripts.com.
- Login or create an account.
- Locate a pharmacy.
Or call Express Scripts at +1 800 987 8360 for more information.