Musculoskeletal Surgery – Knee, Hip, Spine

MMC Benefits Handbook

The plan covers surgical treatment for knee, hip and spine provided by or under the direction of a physician. Claims payments are based on Blue Distinction provider participation.

Prior authorization is required. All services, including surgery, should be obtained from a recognized in-network Blue Distinction provider or cost shares will be higher (summarized below). Contact the Claims Administrator for specific details on requirements and how to find a facility.

See "Travel and Lodging" for information about reimbursement for travel and lodging expenses related to musculoskeletal surgery.


	$1,600 Deductible Plan	$3,200 Deductible Plan
Tier 1: Blue Distinction Provider	Covered at 100% after deductible	Covered at 100% after deductible
Tier 2: In-Network	You pay 20% after deductible	You pay 30% after deductible
Tier 3: Out-of-Network	You pay 40% after deductible	You pay 50% after deductible