MMFS Employee Benefits Guide 2022

MEDICAL BENEFITS

LIBERTY EPO

LIBERTY HDHP EPO

BENEFIT HIGHLIGHT! Oxford Virtual Visits When you need quick care, a Virtual Visit is a convenient way to see a doctor and get on the path to healthier faster. With Oxford’s Virtual Visits, you can see and talk to a doctor via mobile device or computer 24/7, no appointment needed. The doctor can give you a diagnosis and in some cases, even have a prescription delivered to your pharmacy, all in about 20 minutes. Each Virtual Visit costs you $10 . (Please note for members in the HDHP plan, you will need to satisfy the deductible before the $10 copay kicks in.)

BENEFIT

IN-NETWORK

IN-NETWORK

Annual Deductible

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

Individual: $2,000 Family: $4,000 Individual: $3,000 Family: $6,000

Out-of-Pocket Maximum

Coinsurance

100%

100%

Lifetime Maximum

Unlimited

Unlimited

Preventive Care Adult Preventive Care

Covered 100%

Covered 100%

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

100% after deductible 100% after deductible 100% after deductible

Outpatient Lab & X-Ray

Covered 100%

100% after deductible

Inpatient Care

$500 copay per admit

100% after deductible

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

Covered 100% $300 $40

Covered 100% 100% after deductible 100% after deductible

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

Covered 100% $500 copay per admit

Covered 100% 100% after deductible

Mental Health Inpatient Outpatient

$500 copay per admit $40

100% after deductible 100% after deductible

To get started with a Virtual Visit, go to www.uhc.com/ virtualvisits .

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

Subject to Plan Deductible

$15/$35/$75

$15/$35/$75

$37.50/$87.50/$187.50

$37.50/$87.50/$187.50

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