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).
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Plan feature
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$1,600 Deductible Plan4
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$3,200 Deductible Plan4
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Deductible
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Employee: $1,600
Family1: $3,2003
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Employee: $3,200
Family1: $6,4002
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1 "Family" applies to all coverage levels except, Employee-Only.
2 Not "True" Family: For the $3,200 Deductible Plan, 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 covered family member meets his or her individual deductible, benefits begin for only that covered family member, and not for the other covered family members. When the family deductible is met, benefits begin for all covered family members whether or not each has met the individual deductible. The family deductible can only be met by a combination of covered 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 covered family member meets his or her individual out-of-pocket maximum, the out-of-pocket maximum is satisfied for only that covered family member. When the family out-of-pocket maximum is met, the out-of-pocket maximum is satisfied for all covered family members, whether or not each has met the individual out-of-pocket maximum. The family out-of-pocket maximum can only be met by a combination of covered family members, as amounts counted toward individual out-of-pocket maximums count toward the larger family out-of-pocket maximum.
3 "True" Family: For the $1,600 Deductible Plan, 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 met by one covered family member or a combination of family members. This plan does not require that you or a covered family member must meet the "individual" deductible to meet the family deductible. 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 met for any one covered family member only when the family out-of-pocket maximum is met by one covered family member or a combination of covered family members.
4 These plans are named for the deductible applicable to the "individual" for in-network service providers. The deductibles applicable to any other coverage level (for example, "Family coverage") or for services provided by out-of-network service providers will be significantly higher than (in many instances, double) the amounts captured in the names of the plans.
How do deductibles work?
Under the $1,600 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 $3,200, (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 $3,200 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 $1,600 Deductible Plan
Most of your medical and prescription drug expenses (including preventive drugs) apply toward the deductible.
Under the $3,200 Deductible Plan
Most of your medical and prescription drug expenses (including preventive drugs) apply toward the deductible.