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	$1,500 Deductible Plan¹	$3,000 Deductible Plan¹
Annual Deductible	In-network: Employee: $1,500 Family²: $3,000⁴ Out-of-network: Employee: $3,000 Family²: $6,000⁴	In-network: Employee: $3,000 Family²: $6,000³ Out-of-network: Employee: $6,000 Family²: $12,000³
Out-of-Pocket Maximum (including deductible)	In-network: Employee: $3,000 Family²: $6,000⁴ Out-of-network: Employee: $6,000 Family²: $12,000⁴	In-network: Employee: $5,500 Family²: $11,000³ Out-of-network: Employee: $11,000 Family²: $22,000³
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)
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 (90-day supply)
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, Transform Diabetes® Care, WW Digital 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 $3,000 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 that covered family member only, but not for the other covered 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 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 that covered family member only, but not for the other covered 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 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: The $1,500 Deductible Plan does not require that you or a covered 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 covered family member or a combination of covered 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 covered family member or a combination of covered family members.

⁵ With the exception of those impacted by Oklahoma regulations, 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, under Oklahoma law, members will be able to continue filling a 30-day supply of their maintenance medications at any pharmacy in the CVS Caremark network without penalty. Due to Oklahoma regulations, members who are residents of Oklahoma do not have the opportunity to fill any supply (maintenance medications and all other medications) through the CVS Caremark Mail Order pharmacy.