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MACoHCT Benefit Plans


Summary Plan Description (SPD)  |  Benefit Summary

Get Adobe ReaderThe MACoHCT Summary Plan Description is provided in PDF format unless otherwise noted. The free Adobe® Reader® software is required.
 


 

MACo Health Care Trust Summary Plan DescriptionSummary Plan Description (SPD)
Effective July 1, 2016

Amendment #1 to the Summary Plan Description

Amendment #2 to the Summary Plan Description

Amendment #3 to the Summary Plan Description

(The terms of the SPD are effective on July 1, 2016 for all Member Groups regardless of renewal date.)

 

 

 


 

MACo Health Care Trust Benefit SummaryBenefit Summary - July 2017*
Effective July 1, 2017 for groups renewing July 1, 2017

*The Benefit Summary is an easy-to-use reference guide to the benefits available in each MACo Health Care Trust plan. This document is intended only as a summary and does not supersede the more detailed information provided in the Summary Plan Description and Amendments.

 

 


 

The mission of the MACo Health Care Trust is to provide the health benefit package of choice for your county or county-related board or district. MACo Health Care Trust provides multiple benefit plans, excellent customer service, cost-effective management, and a solid financial base. Benefit design options, coupled with multiple deductible selections, enable MACoHCT Member Groups to tailor their plan(s) to local needs.

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.