MMC Benefits Handbook
How the Medical Plan Options Work
All of the medical plan options help you and your family to pay for medical care. As a participant, you may choose, each time you need medical treatment, to use:
  • Any physician, hospital or lab, or
  • A provider who participates in the Anthem BCBS PPO Broad network and has agreed to charge reduced fees to the Plan members. Using the network is more cost effective than using non-network providers because their fees are typically less than those charged by non-network providers.
If you use an in-network provider, you do not need to submit a claim form. In-network providers bill the Claims Administrator directly.
NOTE for the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)):
There is only coverage within the Blue HPN service area. However, urgent and emergency care is covered outside of the service area.
Out-of-network services are not covered under the Anthem BCBS Narrow Network, except for urgent and emergency care. There are some providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem BCBS's provider search (National Blue High Performance Network (Blue HPN)) that can be used and are subject to out-of-network benefit coverage. Providers not labeled as Tier 2 cannot be used for out of network coverage.
Under the $400 Deductible Plan
  • Generally, the Plan's reimbursement is 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. You pay the remainder of the fee. (There are some in-network services that don't apply to the deductible and only require copays).
Under the $900 Deductible Plan
  • Generally, the Plan's reimbursement is 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. You pay the remainder of the fee charged.
Under the $1,500 Deductible Plan
  • Generally, the Plan's reimbursement is 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. You pay the remainder of the fee.
Under the $2,850 Deductible Plan
  • Generally, the Plan's reimbursement is 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 pay the remainder of the fee.
See the "Detailed List of Covered Services" for more detailed information.
Certain expenses are not covered or reimbursed by the Plan, such as any deductible you are required to meet and your share of the amounts above the reasonable and customary charge.
Some services have specific limits or restrictions; see individual service for more information.
Refer to the "What's Not Covered" to find out about the services that are not covered under the Plan.
Benefits are only paid for medically necessary charges or for specified wellness care expenses.
Preauthorization may be required in order to receive coverage for certain services. It is the Plan participant's responsibility (not the provider or facility) to obtain preauthorization for out-of-network services. For more information on the preauthorization process and applicable services, refer to the description under "Utilization Review."