MMC Benefits Handbook
Musculoskeletal Surgery – Knee, Hip, Spine
The plan covers surgical treatment for knee, hip and spine provided by or under the direction of a physician. Claims payments are based on Blue Distinction provider participation.
Prior authorization is required. All services, including surgery, should be obtained from a recognized in-network Blue Distinction provider or cost shares will be higher (summarized below). Contact the Claims Administrator for specific details on requirements and how to find a facility.
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.
  • 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.
 
$400 Deductible Plan
$900 Deductible Plan
$1,500 Deductible Plan
$2,850 Deductible Plan
Tier 1: Blue Distinction Provider
Covered at 100% after deductible
Covered at 100% 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.