MMC Benefits Handbook
Inpatient Hospital and Physician Services
What will the Plan pay if I have to go to the hospital?
The Plan pays inpatient hospital charges at:
Under the $400 Deductible Plan
Under the $900 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers per admission after the Plan's deductible has been met.
Under the $1,500 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers per admission after the Plan's deductible has been met.
Under the $2,850 Deductible Plan
  • 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers per admission after the Plan's deductible has been met.
The Plan will cover the cost of a semi-private room. If you use a private room, the Plan will cover the amount up to the semi-private room rate.
You must obtain preauthorization as soon as possible but at least 14 days before you are admitted for a non-emergency hospital stay.
What approvals do I need if I am going into the hospital?
Preauthorization as soon as possible but at least 14 days before you are admitted for a non-emergency hospital admission or stay.
If you have an emergency hospital admission, surgery or specified procedure, you, a family member, your physician or the hospital must preauthorize within 48 hours of the service.
Does the Plan cover hospital visits by a physician?
While you are in the hospital, the Plan covers hospital visits by a physician at:
Under the $400 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $900 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $1,500 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $2,850 Deductible Plan
  • 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Does the Plan cover ambulance charges?
The Plan covers transportation by ambulance to a medical facility at:
Under the $400 Deductible Plan
  • 80% for in-network providers and 80% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $900 Deductible Plan
  • 80% for in-network providers and 80% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $1,500 Deductible Plan
  • 80% for in-network providers and 80% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $2,850 Deductible Plan
  • 70% for in-network providers and 70% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Coverage includes charges for transportation to a hospital by air or water ambulance when:
  • Ground ambulance transportation is not available.
  • Your condition is unstable and requires medical supervision and rapid transport.
  • In a medical emergency, transportation from one hospital to another hospital; when the first hospital does not have the required services or facilities to treat your condition and you need to be transported to another hospital and the above two conditions are met.
Does the Plan cover hospice care?
The Plan covers charges for hospice at:
Under the $400 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $900 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $1,500 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $2,850 Deductible Plan
  • 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
You must obtain preauthorization before you receive hospice care.