MedMutual

Market HMO Young Adult Essentials - Northern Ohio

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $8,700 Family: $17,400 Per Person: $8,700
Combined Medical and Drug Out of Pocket Maximum	Individual: $8,700 Family: $17,400 Per Person: $8,700

Office Visit

Primary Doctor	CoPay: $40.00 CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: The first 3 combined visits to Primary Care Physician, Other Practitioner, Outpatient Substance Abuse, or Outpatient Mental Health are subject to Copay. After 3 visits, subject to Deductible and Coinsurance. On Demand Telemedicine: 0% after $0 Copay, unlimited visits.
Specialist	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered

Prescription Drug Information

Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Preferred Brand-name drugs, your second cost-share tier, are included in Medical Mutual's formulary and are typically less expensive than similar Non-preferred Brand-name drugs. They are safe, effective alternatives to other brand-name drugs that may cost more. If you fill a Preferred Brand-name drug at an out-of-network pharmacy, you must pay the entire amount and file a claim form with Medical Mutual.
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Non-preferred Brand-name drugs, your third cost-share tier, are included in Medical Mutual’s formulary but are typically more expensive than similar Preferred Brand-name drugs. If you fill a Non-preferred Brand-name drug at an out-of-network pharmacy, you must pay the entire amount and file a claim form with Medical Mutual.
Generic Drugs	CoPay: $0.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Tier 1 Generics include only the drugs listed on the Medical Mutual Standard Plus Preventive Medications List. Tier 2 Generics are all other generic medications listed on Comprehensive High Performance Plus Formulary under Tier 1. To view the Standard Plus Preventive Medications list, visit https://www.MedMutual.com/StandardPlus. Generic drugs are copies of brand-name drugs that contain the same active ingredients but are usually less expensive. They also must meet the same strict U.S. Food and Drug Administration (FDA) standards for quality, strength and purity. If you fill a Generic drug at an out-of-network pharmacy, you must pay the entire amount and file a claim form with Medical Mutual.
Specialty Drugs	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Specialty drugs must be obtained through a contracted specialty pharmacy, and are limited to a 30-day supply.

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Limited to a combined 60 days per Benefit Period maximum for both Inpatient and outpatient day rehabilitation therapy services.
Inpatient Services	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered Benefit Explanation: One (1) Inpatient visit per day per Physican or other Professional Provider

Emergency and Urgent Care

Emergency Room	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered
Urgent Care Facility	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 0.00% Coinsurance after deductible Covered: Covered

Vision

Routine Eye Exams For Children

CoPay: Not Applicable
CoInsurance: No Charge
Covered: Covered
Benefit Explanation: Preventive services only. See plan certificate for more information.

Major Dental Care

Routine Dental Checkups for Children	CoPay: Not Applicable CoInsurance: No Charge Covered: Covered Limit Quantity: 2 Limit Unit : Exam(s) per Benefit Period
Routine Dental Checkups for Adults	Covered: Not Covered
Basic Dental Care - Adult	Covered: Not Covered
Basic Dental Care - Child	CoPay: Not Applicable CoInsurance: No Charge Covered: Covered
Major Dental Care - Adult	Covered: Not Covered
Major Dental Care - Child	CoPay: Not Applicable CoInsurance: No Charge Covered: Covered

Related Articles

You may be interested in these relevant articles from across the HealthMarkets.com network.

What Every Medicaid Member Needs to Know About Redetermination

In September 2021, a research report from the Urban Institute made a startling prediction:…Read More

Read More

How To Be An Alzheimer’s Caregiver: 5 Things You Need To Know

Are you an Alzheimer’s caregiver for a spouse, family member, or friend? You’re not…Read More

Read More

Hand calluses hurt? 5 smart tips to treat and prevent calluses

Hand calluses hurt? If you lift weights, play guitar, or work with your hands…Read More

Read More