MMC Benefits Handbook
What's Covered
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) 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 covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
Pre-existing Conditions
There are no exclusions, limitations or waiting periods for pre-existing conditions for you or any covered family members.
Are immunizations for business travel covered under the Plan?
The Plan does not cover immunizations for business travel.
Is acupuncture covered under the Plan?
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) 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 covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
The Plan covers acupuncture when it is:
  • performed by a physician as a form of anesthesia in connection with surgery or dental procedure that is covered under the Plan.
  • a form of Alternative Treatment as long as it is rendered by a certified/licensed individual.
Coverage is limited to 12 visits per year.
Are insulin pump supplies covered under the medical coverage?
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) 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 covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
Yes. Insulin pump supplies are covered under the medical coverage. Insulin pump supplies are not covered under the prescription drug coverage. Any disposable syringes used in conjunction with insulin pump treatment would be covered under the pharmacy benefit.
Can a prosthetic device be replaced?
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) except for urgent and emergency care. There are some providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem's provider search (National Blue High Performance (Blue HPN network) that can be used and are covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
The Plan covers the replacement of prosthetic devices when medically necessary. The Plan does not cover replacements due to loss or misuse.
Are wigs covered?
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) 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 covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
The Plan will pay benefits for wigs when medically necessary up to one per calendar year per covered member.