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Benefits FAQ
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What is an HMO? A Health Maintenance organization, or HMO, is a comprehensive, pre-paid medical plan that offers physician services as well as hospitalization coverage. The carrier contracts with physicians, hospitals, pharmacies, and other health care professionals to form a closed network, and participants are required to access care through this network.
Who is a PCP? A PCP, or Primary Care Physician, is the gatekeeper through which HMO services are obtained. Usually a General Practitioner, Internist or Pediatrician, this doctor is selected by the participant at the time of enrollment, and he or she coordinates all care received under the plan. The PCP is responsible for issuing referrals for specialist care, as well as authorizing hospitalization and emergency care.
What is an IPA? The HMO plans currently offered by MMC through United HealthCare and Blue Shield use IPA’s, or Independent Practice Associations, to deliver services. IPA’s are contractual alliances between groups of health care providers. The participating physicians maintain their own practices, but process referrals and obtain payment for HMO services through the IPA group. Your PCP will be a member of a specific IPA, and specialist referrals from this physician will usually be to other physicians within the same IPA.
What is a PPO? A PPO, or Preferred Provider Organization is a health plan based upon a contractual arrangement between the insurance carrier and individual providers of care (physicians, hospitals, pharmacies, etc.). PPOs lower out of pocket costs as an incentive to encourage participants to utilize their services.
Can I use any doctor I want? Although some services, such as preventive care, are NOT covered unless a Participating Physician is used, in most cases you are free to see any licensed health care provider, regardless of their affiliation with the carrier. You will be subject to higher copay costs for using out of network providers.
Do these plans have deductibles? YES: A deductible is the out of pocket expenses that you, the insured, must pay before the carrier will begin reimbursement. This amount varies depending upon the plan option that you select.
What is a POS? A Point of Service (POS) plan is a hybrid plan containing features of both HMO and PPO plan designs. Your out-of-pocket costs are determined by how YOU chose to access care. You can access care within the HMO network, using a PCP and referrals, and pay copays with no deductible. If you chose to use a PPO physician, you can access care without a referral, but you are subject to a deductible and coinsurance percentages. If you chose to access care from a provider outside of the PPO network, you will be subject to the deductible, coinsurance and balance billing.
Where can I get more information on the plans MMC offers? Current employees can contact the MMC Benefits Department at (800) 899-6624, extension 400.
Do I have to enroll in Health Insurance to obtain dental and /or vision? NO: MMC’s dental and vision coverages are offered independently, on a completely voluntary basis. Dependent coverages are also voluntary, and do not need to mirror other enrollments.
DMO, PDO…. what’s the difference? A DMO is similar to an HMO health plan. You select a dentist from the panel of pre-approved providers, and this dentist coordinates all care for yourself and your family under the plan. (See HMO section above for more information)
How does "FREEDOM OF CHOICE" work? MMC offers a “Freedom of Choice” Plan. Under this plan, you are free to elect either DMO or PDO coverage, and can move between the two as often as once per month, to meet your specific needs. Specific rules and limitations apply, so please speak to a Benefits representative if you have any questions.
Is there a waiting period for major services? NO: you may utilize the plan for any needed services immediately upon enrollment!
Do I need to select a doctor when I enroll? NO: VSP has an extensive network of doctors: all you need to do is identify yourself as a VSP subscriber, and the provider will take care of the rest! If you chose to use a provider who is not a member of VSP, you can still file a claim with the carrier and obtain reimbursements.
How does the 401(k) Tax deferred retirement plan work? Our retirement years should be as fun filled and carefree as a summer vacation, but will Social Security be enough to make this a reality? Beginning last year, the Social Security Administration began distributing annual estimates of personal benefits to all workers over age 25. If you did not receive one, you may request the information at:
What are the enrollment restrictions? To participate, you must: - Work at least 30 hours per week All new employees who meet the enrollment criteria are eligible to participate the first of the month following 30 days of employment. Continuing employees can enroll at the first of each quarter (January 1, April 1, July 1, October 1).
I’m already enrolled, when can I make changes to my deferral? Changes to your deferral percentage can be made at the beginning of each quarter. There is also an emergency bail-out feature, which allows you to move your deductions to 0% at any time to accommodate emergencies or unexpected expenses. Once your deductions move to 0%, you cannot raise the percentage again until the next quarterly open enrollment point.
If I do not use up the funds in my Reimbursement Account, what happens then? According to IRS regulations, and monies that you defer into the account but cannot provide documentation indicating valid expenses is FORFEIT!!! Due to this factor, it is IMPERATIVE that you discuss any election with a representative prior to signing to decrease the potential for loss! When in doubt, estimate CONSERVATIVELY!!
How do I know if this plan will work for me? The Premium-Only option benefits anyone who pays for all or part of their MMC group health care premiums.
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