MMC Benefits Handbook
The Medical Plan Options at a Glance
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."
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Plan feature
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$1,600 Deductible Plan1
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$3,200 Deductible Plan1
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Annual Deductible
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In-network:
Employee: $1,600
Family2: $3,2004
Out-of-network:
Employee: $3,200
Family2: $6,4004
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In-network:
Employee: $3,200
Family2: $6,4003
Out-of-network:
Employee: $6,400
Family2: $12,8003
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Out-of-Pocket Maximum
(including deductible)
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In-network:
Employee: $3,200
Family2: $6,4004
Out-of-network:
Employee: $6,400
Family2: $12,8004
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In-network:
Employee: $5,900
Family2: $11,8003
Out-of-network:
Employee: $11,800
Family2: $23,6003
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Plan Coinsurance
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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)
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Physician office visits
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Preventive Visit
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In-network: Covered at 100%
Out-of-network: 60% coinsurance after deductible
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In-network: Covered at 100%
Out-of-network: 50% coinsurance after deductible
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Primary Care Physician (PCP)/Specialist Visit
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In-network: 80% coinsurance after deductible
Out-of-network: 60% coinsurance of R&C after deductible
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In-network: 70% coinsurance after deductible
Out-of-network: 50% coinsurance of R&C after deductible
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Specialist Visit
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In-network: 80% coinsurance after deductible
Out-of-network: 60% coinsurance of R&C after deductible
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In-network: 70% coinsurance after deductible
Out-of-network: 50% coinsurance of R&C after deductible
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Hospital Facility
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Inpatient
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In-network: 80% coinsurance after deductible
Out-of-network: 60% coinsurance after deductible
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In-network: 70% coinsurance after deductible
Out-of-network: 50% coinsurance after deductible
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Outpatient
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In-network: 80% coinsurance after deductible
Out-of-network: 60% coinsurance after deductible
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In-network: 70% coinsurance after deductible
Out-of-network: 50% coinsurance after deductible
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Emergency Room (waived if admitted)
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In and Out-of-network: 80% coinsurance after deductible
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In and Out-of-network: 70% coinsurance after deductible
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Prescription drugs
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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.
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Retail Prescriptions
(30-day supply)
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80% coinsurance after deductible
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70% coinsurance after deductible
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80% coinsurance after deductible
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70% coinsurance after deductible
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80% coinsurance after deductible
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70% coinsurance after deductible
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CVS Caremark® Retail and CVS Caremark® Maintenance Choice Program Mail-order Prescriptions5,6
(90-day supply)
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80% coinsurance after deductible
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70% coinsurance after deductible
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80% coinsurance after deductible
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70% coinsurance after deductible
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80% coinsurance after deductible
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70% coinsurance after deductible
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Prescription Drug Programs
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There are prescription drug programs available as part of the medical plan options. For information on Rx Savings Solutions, Transform Diabetes® Care, WW Digital Program and Hello Heart, refer to "Prescription Drug Programs."
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Contact Information for Third Party Administrator options:
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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.
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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 $3,200 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
4 "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.
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 November 1, 2023, members will be able to fill a 90-day supply of their maintenance medications at any pharmacy in Oklahoma that participates in the CVS Caremark Retail 90 network or through the CVS Caremark Mail Order Pharmacy. To locate an in- network pharmacy in the CVS Caremark Retail 90 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 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 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 those prescriptions filled in Florida, effective January 1, 2024, members will be able to fill a 90-day supply of their maintenance medications at any pharmacy in Florida that participates in the CVS Caremark Retail 90 network or through the CVS Caremark Mail Order Pharmacy. To locate an in- network pharmacy in the CVS Caremark Retail 90 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 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, 2024, members will be able to fill a 90-day supply of their maintenance medications at any pharmacy in West Virginia that participates in the CVS Caremark Retail 90 network or through the CVS Caremark Mail Order Pharmacy. To locate an in-network pharmacy in the CVS Caremark Retail 90 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 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.
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.