MMC Benefits Handbook
Deductibles
The deductible is the amount that must be paid before the Plan will reimburse any benefits.
The deductibles vary under each of the medical plan options available to you (as shown in the table below.
Plan feature
$400 Deductible Plan
$900 Deductible Plan
$1,500 Deductible Plan
$2,850 Deductible Plan
Deductible
In-network:
Employee: $400
Family2: $8003
Out-of-network:
Employee: $2,500
Family2: $5,0003
In-network:
Employee: $900
Family2: $1,8003
Out-of-network:
Employee: $3,000
Family2: $6,0003
In-network:
Employee: $1,500
Family2: $3,0004
Out-of-network:
Employee: $3,000
Family2: $6,0004
In-network:
Employee: $2,850
Family2: $5,7003
Out-of-network:
Employee: $5,700
Family2: $11,4003
2 "Family" applies to all coverage levels except Employee-Only.
3 Not "True" Family: If more than one person in a family is covered under this plan, there are two ways the plan will begin to pay benefits for a covered family member. When a family member meets his or her individual deductible, benefits begin for that family member only, but not for the other family members. When the family deductible is met, benefits begin for every covered family member whether or not they have met their own individual deductibles. The family deductible can only be met by a combination of family members, as amounts counted toward individual deductibles count toward the larger family deductible. The out-of-pocket maximum functions in the same way. When a family member meets his or her individual out-of-pocket maximum, the out-of-pocket maximum is satisfied for that family member only, but not for the other family members. When the family out-of-pocket maximum is met, the out-of-pocket maximum is satisfied for every covered family member whether or not they have met their own individual out-of-pocket maximums. The family out-of-pocket maximum can only be met by a combination of family members, as amounts counted toward individual out-of-pocket maximums count toward the larger family out-of-pocket maximum.
4 "True" Family: This plan does not require that you or a covered eligible family member meet the "individual" deductible in order to satisfy the family deductible. If more than one person in a family is covered under this plan, benefits begin for any one covered family member only after the family deductible is satisfied. The family deductible may be met by one family member or a combination of family members. The out-of-pocket maximum functions in the same way. If more than one person in a family is covered under this plan, the out-of-pocket maximum is satisfied for any one covered family member when the family out-of-pocket maximum is satisfied. The family out-of-pocket maximum may be met by one family member or a combination of family members.
Do in-network claims apply toward the out-of-network deductible?
No. Only out-of network claims apply toward the out-of-network deductible.
Do out-of-network claims apply toward the in-network deductible?
Yes. Out-of-network claims apply toward the in-network deductible. Also, in-network claims apply toward the in-network deductible.
How do deductibles work?
Under the $400 Deductible Plan
The Plan will begin reimbursing benefits for a covered family member once he or she has met the individual deductible (even if the entire family deductible has not been met). The family deductible is the maximum amount you have to pay before the Plan will reimburse any benefits. Copays for doctor visits (including ER and urgent care) and prescription drugs do not count toward the deductibles for the $400 Deductible Plan. A deductible will not apply for a newborn child whose length of stay in the hospital is the same as the mother's length of stay.
Under the $900 Deductible Plan
The Plan will begin reimbursing benefits for a covered family member once he or she has met the individual deductible (even if the entire family deductible has not been met). The family deductible is the maximum amount you have to pay before the Plan will reimburse any benefits. Prescription drugs do not count toward the deductibles for the $900 Deductible Plan. A deductible will not apply for a newborn child whose length of stay in the hospital is the same as the mother's length of stay.
Under the $1,500 Deductible Plan
If the "employee" coverage level is elected, the Plan will begin reimbursing benefits for the one covered individual once he or she has met the individual deductible. For any other coverage level (employee + spouse, employee + child(ren) or family, the Plan will begin reimbursing benefits for a covered family member (including a newborn) once the family deductible is met. In meeting your family deductible, each family member's (including a newborn's) covered expenses (medical and prescription drug expenses) count toward the family deductible. Once this family deductible is met, the Plan will pay benefits for all family members.
Under the $2,850 Deductible Plan
The Plan will begin reimbursing benefits for a covered family member once he or she has met the individual deductible (even if the entire family deductible has not been met). The family deductible is the maximum amount you have to pay before the Plan will reimburse any benefits. A deductible will not apply for a newborn child whose length of stay in the hospital is the same as the mother's length of stay.
Do I have to meet a new deductible every year?
You and your family members will have to meet a new deductible each year.
What expenses apply toward the deductible?
Most of your medical expenses apply toward the deductible. Office visits (including ER and urgent care) and Prescription drug expenses do not apply to the deductible for the $400 Deductible Plan. Prescription drug expenses do not apply to the deductible for the $900 Deductible Plan.
Under the $1,500 Deductible Plan and the $2,850 Deductible Plan, prescription drug expenses (other than preventive drug expenses) also apply toward the deductible.
Your payments for the following don't apply toward the Plan deductible:
  • Amounts in excess of a reasonable and customary charge
  • Preauthorization penalties
  • Services not covered by the Plan
Under the $400 Deductible Plan
  • Prescription Drugs
  • Office visit copays
Under the $900 Deductible Plan
  • Prescription Drugs
Under the $1,500 Deductible Plan
  • Amounts exceeding the network negotiated price for prescription drugs (other than preventive drugs)
Under the $2,850 Deductible Plan
  • Amounts exceeding the network negotiated price for prescription drugs (other than preventive drugs)
Do preventive drug expenses apply toward the deductible?
Preventive drugs as defined by the Patient Protection Affordable Care Act for the $400 Deductible Plan, the $900 Deductible Plan, the $1,500 Deductible Plan and $2,850 Deductible Plan are covered with no cost sharing (i.e. deductible, coinsurance, copay). Certain examples include: aspirin products, fluoride products, folic acid products, immunizations, contraceptive methods, smoking cessation products, bowel preps, primary prevention of breast cancer and statins.
If you enrolled in the $1,500 Deductible Plan or the $2,850 Deductible Plan, there are certain preventive medications that are not subject to the deductible. Certain examples include: hypertension, diabetes, asthma, and cholesterol lowering drugs.
Call Express Scripts at +1 800 987 8360 for more information about preventive drugs or log on to the Drug Pricing Tool. Follow the provided steps to access the Drug Pricing Tool.
  • Log on to express-scripts.com.
  • Login or create an account.
  • Prescriptions.
  • Price a medication.
  • Choose a pharmacy and enter drug name.