MMC Benefits Handbook
How the Plan Works
This plan helps you and your family to pay for medical care and prescription drugs. As a participant, you may choose, each time you need medical treatment, to use:
- Any physician, hospital or lab, or
- A provider who participates in the UnitedHealthcare Choice Plus (Broad Network) and has agreed to charge reduced fees to the Plan members. Using the network is more cost effective than using non-network providers because their fees are typically less than those charged by non-network providers.
If you use an in-network provider, you do not need to submit a claim form. In-network providers bill the Claims Administrator directly.
See the "Detailed List of Covered Services" for more detailed information.
Certain expenses are not covered or reimbursed by the Plan, such as your share of the amounts above the reasonable and customary charge.
Some services have specific limits or restrictions; see individual service for more information.
Refer to the "What's Not Covered" to find out about the services that are not covered under the Plan.
Benefits are only paid for medically necessary charges or for specified wellness care expenses.
Prior authorization may be required in order to receive coverage for certain services. It is the Plan participant's responsibility (not the provider or facility) to obtain prior authorization for out-of-network services. For more information on the prior authorization process and applicable services, refer to the description under "Utilization Review."
The Plan has no deductible or coinsurance. Medical services and prescription drugs are subject to a copay. You pay a copay based on the care you receive and the provider you chose. A copay is the flat dollar amount you pay for covered services and prescription drugs under the Plan. Copays count toward an out-of-pocket maximum (the maximum amount you will pay in out-of-pocket expenses during the plan year).
When you need care, you'll be able to research providers and view copays for providers, procedures, and treatment options before you make an appointment. The copays will vary based on the covered service, the provider and whether the provider is in-network.
To locate in-network providers, search for medical services, see the amount you will pay for care (copay amounts), compare costs for treatments and procedures, call Member Services at +1 866 683 6440, visit the Surest Mobile App or Benefits.Surest.com. See the Networks section for search instructions.
You pay a copay for prescription drugs depending on the tier of the drug (i.e., generic, formulary brand or non-formulary brand drug). For information on covered medications with CVS Caremark® and the costs, visit www.caremark.com.