|
Plan feature
|
In-network
|
Out-of-network
|
|
Deductible
|
Individual: $400 per individual
Family: $1,000 maximum
|
Individual: $800 per individual
Family: $2,000 maximum
|
|
Out-of-pocket maximum
|
Individual: $2,500 per individual
Family: $6,250 maximum
|
Individual: $5,000 per individual
Family: $12,500 maximum
|
|
Coverage levels
|
80% after deductible
|
60% after deductible
(Out-of-network benefits are based on reasonable and customary charges)
|
|
Prescription drugs
|
There is a pharmacy network for retail and Medco By Mail for mail order prescription drugs
|
There is a pharmacy network for retail prescription drugs
|
|
Contact Information
|
For Medical Services:
Aetna (Claims Administrator)
P.O. Box 981109 El Paso, TX 79998-1109 Aetna Customer Service: +1 866 210 7858 Website: www.aetna.com/docfind/custom/mmc
For Prescription Drug Coverage:
Medco (Pharmacy Benefits Manager)
Medco Customer Service: +1 800 987 8360 Website (for members): www.medco.com
Marsh & McLennan Companies does not administer claims under this Plan. For medical claims, Aetna's decisions are final and binding; for prescription drug services, Medco's decisions are final and binding.
|
|