Affordable Routine Care
- $0 monthly premium available on Classic HMO
- $5 copay for primary care visits on Classic HMO
- $0 copays for Tier 1 and Tier 2 prescription drugs through mail-order on Classic HMO
Extra Coverage That Matters
- $499 copay for standard hearing aids on all plans
- $200 eyewear allowance on our Select PPO plan and $100 on Classic HMO plans
- SilverSneakers® fitness membership included at no additional cost on all plans
- Transportation benefit now available without inpatient requirement
| MedMutual Advantage Classic HMO |
MedMutual Advantage Select PPO | |
|---|---|---|
| Plan Number | H6723-001-002 | H4497-001-002 |
| Good Fit For: Learn more about our customer personas |
Managing Care Needs | |
| Premium | $0 | $93 |
| MOOP | $4,800 | IN: $6,990 OON: $11,300 |
| PCP | $0 | IN: $5 OON: 30% |
| Specialist | $25 | IN: $45 OON: 30% |
| Podiatry | $35 | IN: $45 OON: 30% |
| Inpatient | $285 (Day 1-6) | IN: $410 (Days 1-5) OON: 30% |
| Outpatient (Surgical) | $360 | IN: $400 OON: 30% |
| Diagnostic | CT: $150 MRI: $225 PET: $225 |
CT: $150 MRI: $225 PET: $225 OON: 30% for all |
| ER (waived if admitted within 24 hours) | $110 | $110 |
| Urgent Care | $45 | IN/OON: $45 |
| Rx Deductible | $95 (Excludes Tier 1, 2) | $95 (Excludes Tier 1 and 2) |
| Preferred Rx Copays – 30 Day Retail | Tier 1: $0 Tier 2: $5 Tier 3: $42 Tier 4: 50% Tier 5: 31% |
Tier 1: $0 Tier 2: $5 Tier 3: $42 Tier 4: 50% Tier 5: 31% |
| Preferred Rx Copays – 90 Day Mail Order | Tier 1: $0 Tier 2: $0 Tier 3: $110 Tier 4: 50% Tier 5: NC |
Tier 1: $0 Tier 2: $10 Tier 3: $110 Tier 4: 50% Tier 5: NC |
| Visitor/Travel Benefit | $7,500 | $7,500 |
| Dental | Preventive | Preventive |
| OTC | Not Included | Annually: $120 Quarterly: $30 |
| Vision | Exam: $0 Allowance: $200 |
Exam: $0-IN 50% OON Allowance: $100 |
| Hearing | Exam: $0 Hearing Aid Copay: As low as $499 |
Exam: $0 (30% OON) Hearing Aid Copay: As low as $499 |