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
Employee: $400
Family1: $8002
Employee: $900
Family1: $1,8002
Employee: $1,500
Family1: $3,0003
Employee: $2,850
Family1: $5,7002
1 "Family" applies to all coverage levels except, Employee-Only.
2 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 one family member or 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 one family member or a combination of family members, as amounts counted toward individual out-of-pocket maximums count toward the larger family out-of-pocket maximum.
3 "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.
How do deductibles work?
Under the $400 Deductible Plan
The Plan will begin reimbursing benefits for a covered family member (including a newborn) 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. Doctor visit copays (including ER and urgent care) and prescription drugs do not count toward the deductible for the $400 Deductible Plan.
Under the $900 Deductible Plan
The Plan will begin reimbursing benefits for a covered family member (including a newborn) 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 deductible for the $900 Deductible Plan.
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 all regions except California, 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.
In California only, the Plan will begin reimbursing benefits for a covered family member (including a newborn) once he or she has met a deductible of $2,600, (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.
Under the $2,850 Deductible Plan
The Plan will begin reimbursing benefits for a covered family member (including a newborn) 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.
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?
Under the $400 Deductible Plan
Most of your medical expenses apply toward the deductible. Doctor visit copays (including ER and urgent care) and prescription drug expenses do not count toward the deductible for the $400 Deductible Plan.
Under the $900 Deductible Plan
Most of your medical expenses apply toward the deductible. Prescription drug expenses do not count toward the deductible for the $900 Deductible Plan.
Under the $1,500 Deductible Plan
Most of your medical and prescription drug expenses (including preventive drugs) apply toward the deductible.
Under the $2,850 Deductible Plan
Most of your medical and prescription drug expenses (including preventive drugs) apply toward the deductible.