The Medical Plan Options at a Glance

MMC Benefits Handbook

The chart below outlines some important Plan features and coverage information that distinguish the two available Aetna medical plan options. The plan features described below (deductibles, coinsurance, etc.) are the same under the Broad Network and the Narrow Network. Additional information is provided throughout this section of the Benefits Handbook including the "Detailed List of Covered Services."


Plan feature	$1,650 Deductible Plan¹	$3,300 Deductible Plan¹
Annual Deductible	In-network: Employee: $1,650 Family²: $3,300⁴ Out-of-network: Employee: $3,300 Family²: $6,600⁴	In-network: Employee: $3,300 Family²: $6,600³ Out-of-network: Employee: $6,600 Family²: $13,200³
Out-of-Pocket Maximum (including deductible)	In-network: Employee: $3,300 Family²: $6,600⁴ Out-of-network: Employee: $6,600 Family²: $13,200⁴	In-network: Employee: $6,600 Family²: $13,200³ Out-of-network: Employee: $13,200 Family²: $26,400³
Plan Coinsurance	In-network: 80% coinsurance after deductible Out-of-network: 60% coinsurance after deductible (Out-of-network benefits are based on reasonable and customary charges)	In-network: 70% coinsurance after deductible Out-of-network: 50% coinsurance after deductible (Out-of-network benefits are based on reasonable and customary charges)
Physician office visits
Preventive Visit	In-network: Covered at 100% Out-of-network: 60% coinsurance after deductible	In-network: Covered at 100% Out-of-network: 50% coinsurance after deductible
Primary Care Physician (PCP)/Specialist Visit	In-network: 80% coinsurance after deductible Out-of-network: 60% coinsurance of R&C after deductible	In-network: 70% coinsurance after deductible Out-of-network: 50% coinsurance of R&C after deductible
Specialist Visit	In-network: 80% coinsurance after deductible Out-of-network: 60% coinsurance of R&C after deductible	In-network: 70% coinsurance after deductible Out-of-network: 50% coinsurance of R&C after deductible
Hospital Facility
Inpatient	In-network: 80% coinsurance after deductible Out-of-network: 60% coinsurance after deductible	In-network: 70% coinsurance after deductible Out-of-network: 50% coinsurance after deductible
Outpatient	In-network: 80% coinsurance after deductible Out-of-network: 60% coinsurance after deductible	In-network: 70% coinsurance after deductible Out-of-network: 50% coinsurance after deductible
Emergency Room (waived if admitted)	In and Out-of-network: 80% coinsurance after deductible	In and Out-of-network: 70% coinsurance after deductible
Prescription drugs	There is a CVS Caremark® Retail Pharmacy Network for 30-day supply (acute) and CVS Caremark® Retail and CVS Caremark® Mail Order for 90-day supply (maintenance) Prescription drugs.
Retail Prescriptions (30-day supply) NOTE: THIS DOES NOT APPLY TO INFERTILITY PRESCRIPTIONS. See Prescription Drugs – WINFertility ("WIN") – Infertility Prescriptions Only for more information.
Generic	80% coinsurance after deductible	70% coinsurance after deductible
Formulary Brand	80% coinsurance after deductible	70% coinsurance after deductible
Non-Formulary Brand	80% coinsurance after deductible	70% coinsurance after deductible
CVS Caremark® Retail and CVS Caremark® Maintenance Choice Program Mail-order Prescriptions⁵,⁶ (90-day supply) NOTE: THIS DOES NOT APPLY TO INFERTILITY PRESCRIPTIONS. See Prescription Drugs – WINFertility ("WIN") – Infertility Prescriptions Only for more information.
Generic	80% coinsurance after deductible	70% coinsurance after deductible
Formulary Brand	80% coinsurance after deductible	70% coinsurance after deductible
Non-Formulary Brand	80% coinsurance after deductible	70% coinsurance after deductible
Prescription Drug Programs	There are prescription drug programs available as part of the medical plan options. For information on Rx Savings Solutions, WW Core Membership Program and Hello Heart, refer to "Prescription Drug Programs."
Contact Information for Third Party Administrator options:	Contact for Medical Service: Aetna (Claims Administrator) P.O. Box 981106 El Paso, TX 79998-1106 Aetna Customer Service: +1 866 210 7858 Website: www.aetna.com Contact for Prescription Service: CVS Caremark® (Prescription Drug Benefits Manager) Phone: +1 844 449 0362 Website (for members): www.caremark.com CVS Caremark® Group #: 21CW Marsh McLennan does not administer claims under this plan. For medical claims, the Claims Administrators' decisions are final and binding. For prescription drug claims, the Prescription Drug Benefits Manager's decisions are final and binding.

¹ 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.

² "Family" applies to all coverage levels except Employee-Only.

³ Not "True" Family: For the $3,300 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

⁴ "True" Family: For the $1,650 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.

⁵ In addition to mail order, you will be able to fill a 90-day supply of your maintenance medications at a CVS Caremark® retail pharmacy, at the same cost as you would through the mail order program. For all maintenance medications, after the first three fills, you must fill a 90-day supply either at a CVS Caremark® retail pharmacy or through the CVS Caremark® Maintenance Choice Mail Order program otherwise, the maintenance medication will not be covered, you will pay 100% of the full cost for all subsequent fills, and the cost does not accumulate towards the deductible and out-of-pocket maximum.

For those prescriptions filled in Oklahoma, effective January 1, 2025, members will be required to fill 90-day supplies of medications at select participating pharmacies in the Maintenance Choice network. To locate an in- network pharmacy in the CVS Caremark Maintenance Choice network, go to www.caremark.com, Select Plan & Benefits, then select Pharmacy locator. For more information, refer to "Is there a network of pharmacies for CVS Caremark®?."

For those prescriptions filled in Minnesota, effective July 1, 2023, members will be able to fill a 90-day supply of their maintenance medications at any pharmacy in Minnesota that participates in the CVS Caremark Maintenance Choice network (includes CVS Retail stores and the CVS Caremark Mail Order Pharmacy). To locate an in-network pharmacy, go to www.caremark.com, Select Plan & Benefits, then select Pharmacy locator. For more information, refer to "Is there a network of pharmacies for CVS Caremark®?."

For specialty medications in Minnesota, effective January 1, 2024, members will be able to fill their specialty medications at any pharmacy that is able to dispense specialty medications in the state of Minnesota in addition to CVS specialty.

For those prescriptions filled in Tennessee, effective October 1, 2023, members will be able to fill a 90-day supply of their maintenance medications at any pharmacy in Tennessee that participates in the CVS Caremark Maintenance Choice network (includes CVS Retail stores and the CVS Caremark Mail Order Pharmacy). To locate an in-network pharmacy, go to www.caremark.com, Select Plan & Benefits, then select Pharmacy locator. For more information, refer to "Is there a network of pharmacies for CVS Caremark®?."

For those prescriptions filled in Florida, effective January 1, 2025, members will be required to fill 90-day supplies of medications at select participating pharmacies in the Maintenance Choice network. To locate an in- network pharmacy in the CVS Caremark Maintenance Choice network, go to www.caremark.com, Select Plan & Benefits, then select Pharmacy locator. For more information, refer to "Is there a network of pharmacies for CVS Caremark®?."

For specialty medications in Florida, effective January 1, 2024, members will be able to fill their specialty medications through an expanded network that includes CVS Specialty and Publix pharmacies.

For those prescriptions filled in West Virginia, effective January 1, 2025, members will be required to fill 90-day supplies of medications at select participating pharmacies in the Maintenance Choice network. To locate an in-network pharmacy in the CVS Caremark Maintenance Choice network, go to www.caremark.com, Select Plan & Benefits, then select Pharmacy locator. For more information, refer to "Is there a network of pharmacies for CVS Caremark®?."

For specialty medications in West Virginia, effective January 1, 2024, members will be able to fill their specialty medications at any pharmacy that is able to dispense specialty medications in the state of West Virginia in addition to CVS specialty.

For those prescriptions filled in Kentucky effective January 1, 2025, members will be able to fill a 90-day supply of their maintenance medications at any pharmacy in Kentucky that participates in the CVS Caremark Maintenance Choice network (includes CVS Retail stores and the CVS Caremark Mail Order Pharmacy). To locate an in-network pharmacy, go to www.caremark.com, Select Plan & Benefits, then select Pharmacy locator. For more information, refer to "Is there a network of pharmacies for CVS Caremark®?."

⁶ The CVS Maintenance Choice® Program includes CVS Pharmacies and the CVS Caremark® Mail Service Pharmacy. Effective April 1, 2024, the Maintenance Choice® program has been expanded to include Kroger affiliated pharmacies, Costco and its mail pharmacies, and several independent pharmacies. You can log into www.caremark.com to identify and locate select participating pharmacies by using the pharmacy locator tool.