MMC Benefits Handbook
Musculoskeletal Surgery – Knee, Hip, Spine
Aetna's Centers of Excellence, known as Institutes of Quality (IOQ) for Orthopedic is a special network of hospitals and other facilities known for quality care. Aetna's IOQ facilities specialize in
  • Spine surgery - (laminectomy, primary fusion, fusion revision, discectomy (w/out decompression), decompression (w/out fusion)
  • Total joint replacement (knee/hip)
If you utilize an IOQ, your surgery will be covered at 100% after the plan's in-network deductible. Prior authorization is required.
 
$400 Deductible Plan
$900 Deductible Plan
$1,500 Deductible Plan
$2,850 Deductible Plan
Tier 1: Center of Excellence (IOQ)
Covered at 100% after deductible
Covered at100% after deductible
Covered at 100% after deductible
Covered at 100% after deductible
Tier 2: In-Network
You pay 20% after deductible
You pay
20% after deductible
You pay 20% after deductible
You pay 30% after deductible
Tier 3:
Out-of-Network
You pay 40% after deductible
You pay
40% after deductible
You pay 40% after deductible
You pay 50% after deductible
Travel and lodging expenses to and from your home will be reimbursed as defined below.
  • The patient is eligible for reimbursement if the facility is 100 miles or more from the patient's home.
  • The reimbursement for lodging expenses is limited to $50 per night.
  • The maximum reimbursement for all travel and lodging expenses is $10,000 per episode of care.