MMC Benefits Handbook
Preventive/Wellness Care
How is preventive/wellness care covered?
The Plan covers Preventive/Wellness Care at:
Under the $1,600 Deductible Plan
Under the $3,200 Deductible Plan
  • 100% for in-network providers with no deductible and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met. Plan limits apply. Contact the Claims Administrator for specific details.
If covered as part of annual physical, routine hearing screenings performed by a PCP (such as whispered voice, tuning fork), which do not utilize calibrated instruments, covered at 100% with no cost sharing in network.
What services are considered preventive/wellness care?
The Plan considers physician, testing and diagnostic fees for the following specific wellness expenses to be preventive/wellness care:
  • Blood cell counts
  • Blood tests for prostate screening
  • Breastfeeding support, including education for mothers and families as well as direct support for mothers during breastfeeding provided by a certified lactation support provider. Purchase/rental of breast pumps and supplies are subject to third party administrator limitations.
  • Colorectal cancer testing for average-risk members aged 45 years and older
  • Cholesterol tests
  • Mammograms (including 3D mammograms)
  • Pap smears
  • Routine physical exams, including one pelvic exam each calendar year
  • Sigmoidoscopy (covered if you are 45 and over.)
  • Tuberculosis tests
  • Urinalysis.
Not all preventive services are listed above. Contact the Claims Administrator for specific details on preventive services.
The following services are not considered preventive/wellness care:
  • Services which are covered to any extent under any other group plan of your employer.
  • Services which are for diagnosis or treatment of a suspected or identified injury or disease.
  • Exams given while the person is confined in a hospital or other facility for medical care.
  • Services which are not given by a physician or under his or her direct supervision.
  • Medicines, drugs, appliances, equipment, or supplies.
  • Psychiatric, psychological, personality or emotional testing or exams.
  • Exams in any way related to employment or required by a third party such as school or camp.
  • Premarital exams.
  • Vision, hearing, or dental exams.
Does the Plan cover outpatient physician services?
The Plan covers charges for outpatient office visits at:
Under the $1,600 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan deductible has been met.
Under the $3,200 Deductible Plan
  • 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan deductible has been met.
Does the Plan cover gynecology visits?
The Plan covers one routine gynecological exam each calendar year at:
Under the $1,600 Deductible Plan
  • 100% for in-network providers with no deductible and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met as part of preventive/wellness care.
Under the $3,200 Deductible Plan
  • 100% for in-network providers with no deductible and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met as part of preventive/wellness care.
If the visit to the gynecologist is for treatment of a medical condition, it is not considered routine care and will be covered at:
Under the $1,600 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan deductible has been met.
Under the $3,200 Deductible Plan
  • 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers under after the Plan deductible has been met.
Does the Plan cover mammograms?
The Plan covers routine mammograms (including 3D mammograms) at:
Under the $1,600 Deductible Plan
  • 100% for in-network providers with no deductible and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
  • 100% for in-network providers with no deductible and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
There are no age or frequency limitations. It is recommended that members follow the American Cancer Society guidelines for age and frequency to determine when to receive preventive care services.
Does the Plan cover Pap smears?
The Plan covers one routine Pap smear each calendar year at:
Under the $1,600 Deductible Plan
  • 100% for in-network providers with no deductible and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met as part of preventive/wellness care.
Under the $3,200 Deductible Plan
  • 100% for in-network providers with no deductible and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met as part of preventive/wellness care.
If your doctor recommends a non-routine Pap smear as a follow-up to a medical diagnosis, the Plan:
Under the $1,600 Deductible Plan
  • covers your Pap smear at 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
  • covers your Pap smear at 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Does the Plan cover prostate specific antigen (PSA) tests and routine Annual Digital Rectal exams?
The Plan covers routine prostate specific antigen (PSA) tests for covered males (with no age limitations) and routine Annual Digital Rectal Exam (DRE).
Under the $1,600 Deductible Plan
  • 100% for in-network providers with no deductible and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met as part of preventive/wellness care.
Under the $3,200 Deductible Plan
  • 100% for in-network providers with no deductible and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met as part of preventive/wellness care.
If your doctor recommends a non-routine DRE test as a follow-up to a medical diagnosis, the Plan covers your DRE test at:
Under the $1,600 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
  • 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.