MMFS Employee Benefits Guide 2022

MEDICAL BENEFITS

FREEDOM PPO PLAN

SWEAT EQUITY PROGRAM Eligible Oxford plan members can get reimbursed up to $200 in a six-month period. That’s right. Oxford will send you $200 for every six-month period that you are in the program. If your spouse participates, Oxford will send $100 for every six-month period provided you both meet the required goals and submit a completed reimbursement form. Please download the form here . RALLY PROGRAM Learning how to live healthy is easier when you’ve got some help to find your way. That’s what Rally® is all about. It’s a website and a user-friendly digital experience available through oxfordhealth.com ® that will engage you in a new way by using technology, gaming and social media to help support you on your health journey. REAL APPEAL Real Appeal ® is an online weight loss program available to you and eligible family members at no cost as part of your health plan benefits. With one-on-one coaching, digital tools and more, you’ll have the support you need to reach your personal goals.

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Annual Deductible

Individual: None Family: None Individual: $2,500 Family: $5,000

Individual: $2,000 Family: $4,000 Individual: $4,000 Family: $8,000

Out-of-Pocket Maximum

Coinsurance

100%

20%

Lifetime Maximum

Unlimited

Unlimited

Preventive Care Adult Preventive Care

Covered 100%

20% after deductible

Annual Well Woman Visit Adult Annual Physical Exam Well-Child Care

Outpatient Care Primary care physician office visits Specialist office visits Outpatient facility surgery

$25 $40 $250 copay per visit

20% after deductible 20% after deductible 20% after deductible

Outpatient Lab & X-Ray

Covered 100%

20% after deductible

Inpatient Care

$500 copay per admit

20% after deductible

Emergency Care Ambulance when medically necessary Hospital emergency room (waived if admitted) Urgent Care

Covered 100% $300 $40

Covered 100% $300 20% after deductible

Maternity Care Prenatal and Postnatal care Hospital services for mother and child

Covered 100% $500 copay per admit

20% after deductible 20% after deductible

Mental Health Inpatient Outpatient

$500 copay per admit $40

20% after deductible 20% after deductible

Prescription Drug Deductible (Tier 1 waived) Retail Pharmacy (30 day supply) Tier 1/Tier 2/Tier 3 Mail Order (90 day supply) Tier 1/Tier 2/Tier 3

$100

N/A

$15/$35/$75

In-Network Only

$37.50/$87.50/$187.50

In-Network Only

A full Summary of Benefits & Coverage for each plan can be found in the benefits portal and on the Intranet

For more Oxford information

Visit www.myuhc.com or call 800.444.6222

QUESTIONS? Call BenefitsVIP at 866.286.5354