Summary Plan Description
Benefit Summary, July 2018
MACoHCT plan options
- Comprehensive Major Medical Plan – This plan provides broad coverage with a range of deductible options.
- Revised Major Medical Plan – This plan is similar to the Comprehensive Major Medical Plan, with the addition of “first dollar” coverage (deductible waived) for physician office visits, diagnostic X-ray and lab services, chiropractic care, chemical dependency/substance abuse treatment and mental/nervous outpatient office visits. A range of deductible options is available.
- Basic Medical Plan – The Basic Medical Plan provides reduced benefits for those who desire less coverage and a low premium. This plan includes a single deductible and out-of-pocket maximum for both medical and pharmacy charges.
- HSA-Qualifying High Deductible Health Plan – This plan satisfies federal requirements for employees who wish to open a Health Savings Account (HSA). This plan provides broad coverage with a single deductible and out-of-pocket maximum for both medical and pharmacy charges.
In addition, ALL plans provide preventative wellness benefits with no deductible. These benefits provide a tremendous value to all plans by encouraging participants to obtain annual checkups, well-child care, preventive exams, immunizations, diabetic screenings and education, and FREE annual on-site wellness screenings at no out-of-pocket expense.
Pharmacy Benefit Plan: The Comprehensive Major Medical Plan and Revised Major Medical Plan have a separate pharmacy benefit with a $50 deductible per individual. The maximum out-of-pocket limit for prescriptions per benefit year is $1,550 (including deductible). Once the pharmacy maximum out-of-pocket limit is satisfied, the plan pays 100% of all eligible prescriptions for the remainder of the benefit year.
The Basic Medical Plan and HSA-Qualifying High Deductible Health Plan do not have a separate pharmacy benefit. If you are enrolled in the Basic Medical Plan or HSA-Qualifying High Deductible Health Plan, you pay for your prescriptions until your medical deductible is met, and then prescriptions are covered the same as any other medical service. Once the medial maximum out-of-pocket limits is satified, the plan pays 100% of all eligible medical and pharmacy claims for the remainder of the benefit plan year.
Dental and Vision Plans: Member Groups may elect to offer Dental coverage and/or Vision coverage with or without enrollment in a medical plan.
The Summary Plan Description, Amendments and *Benefit Summary provide detailed information about covered services, plan limitations and exclusions, and eligibility for coverage under the MACoHCT benefit plans.