Medical
Find a Provider and Cost Estimates Tool
Different healthcare providers charge different amounts for the same medical services. Know the costs before you make a decision.
Save money – Know where to receive the best care at the best cost. Medical Mutual offers Find a Provider and Cost Estimates Tool, an online tool, to compare costs between doctors and medical service providers.
Log into your My Health Plan account at https://member.medmutual.com/user/login.aspx and click Find a Provider and Cost Estimates Tool to start saving today
Resources
Programs / Resources through MMO
Medical Mutual SuperMed PPO
HOW THE PLAN WORKS
Plan Type: PPO Plan
Preventive Care: The plan pays 100% for in-network preventive care.
Annual Deductible: You pay all non-preventive care costs, including prescription drugs, up to the annual deductible. The annual deductible is $1,250 for Individual and $2,500 for Family when you use in-network providers.
Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 20% for individual and family.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum of either $3,250 for Individual or $6,500 for Family, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
| In-Network | Out-of-Network | |
| Annual Year Deductible (Individual/Family) | $1,250/$2,500 | $2,500/$5,000 |
| Coinsurance | 20% | 40% |
| Out of Pocket Maximum (Includes Deductible) | $3,250/$6,500 | $6,500/$13,000 |
| Preventive Care | Covered at 100% | $25 copay |
| Primary Office Visit (PCP) | $25 copay | Ded + 40% |
| Specialist Office Visit | $50 copay | Ded + 40% |
| Emergency Room Care | $150 copay | $150 copay |
| Urgent Care | $30 copay | Ded + 40% |
PPO HSA
HOW THE PLAN WORKS
Plan Type: HSA Plan
Preventive Care: The plan pays 100% for in-network preventive care.
Annual Deductible: You pay all non-preventive care costs, including prescription drugs, up to the annual deductible. The annual deductible is $3,300 for Individual and $6,600 for Family when you use in-network providers.
Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 20% for individual and family.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum of either $4,000 for Individual or $8,000 for Family, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
Critical Illness Insurance: MMO PPO/HSA Plan enrollees will automatically be enrolled in a MetLife “Critical Illness” policy. There is no additional cost to the participant in the MMO PPO/HSA Plan for this benefit as it is now a stated element of that health plan. This is coverage that can help cover the extra expenses associated with a serious illness. When a serious illness happens to you or a loved one, this coverage provides you with a lump-sum payment up to $12,000 in Initial Benefits upon diagnosis. Payment you receive will be made in addition to any other insurance you may have and may be spent as you see fit.
| In-Network | Out-of-Network | |
| Annual Year Deductible (Individual/Family) | $3,300/$6,600 | $6,000/$12,000 |
| Coinsurance | 20% | 40% |
| Out of Pocket Maximum (Includes Deductible) | $4,000/$8,000 | $8,000/$16,000 |
| Preventive Care | Covered at 100% | $15 copay |
| Primary Office Visit (PCP) | Ded+20% | Ded+40% |
| Specialist Office Visit | Ded+20% | Ded+40% |
| Emergency Room Care | Ded+20% | Ded+20% |
| Urgent Care | Ded+20% | Ded+40% |
Skycare EPO
Plan Type: EPO Plan
Preventive Care: The plan pays 100% for in-network preventive care.
Annual Deductible: You pay all non-preventive care costs, including prescription drugs, up to the annual deductible. The annual deductible is $500 for Individual and $1,000 for Family when you use in-network providers.
Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 10% for individual and family.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum of either $2,000 for Individual or $4,000 for Family, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
What’s an EPO Plan? An Exclusive Provider Organization plan (EPO plan), is a health plan that offers a local network of providers. However, if you choose to get care outside of the plan’s network, the cost will not be covered except in an emergency. The Diocese offers two EPO choices, both of which have lower costs and lower out-of-pocket expenses than the MMO PPO plan.
| In-Network | Out-of-Network | |
| Annual Year Deductible (Individual/Family) | $500/$1,000 | Not Covered |
| Coinsurance | 10% | Not Covered |
| Out of Pocket Maximum (Includes Deductible) | $2,000/$4,000 | Not Covered |
| Preventive Care | Covered at 100% | Not Covered |
| Primary Office Visit (PCP) | $20 copay | Not Covered |
| Specialist Office Visit | $40 copay | Not Covered |
| Emergency Room Care | $150 copay | $150 copay |
| Urgent Care | $25 copay | Not Covered |
Resources
MedFlex EPO
Plan Type: HMO
Preventive Care: The plan pays 100% for in-network preventive care.
Annual Deductible: You pay all non-preventive care costs, including prescription drugs, up to the annual deductible. The annual deductible is $750 for Individual and $1,500 for Family when you use in-network providers.
Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 20% for individual and family.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum of either $2,500 for Individual or $5,000 for Family, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
| In-Network | Out-of-Network | |
| Annual Year Deductible (Individual/Family) | $750/$1,500 | Not Covered |
| Coinsurance | 20% | Not Covered |
| Out of Pocket Maximum (Includes Deductible) | $2,500/$5,000 | Not Covered |
| Preventive Care | Covered at 100% | Not Covered |
| Primary Office Visit (PCP) | $20 copay | Not Covered |
| Specialist Office Visit | $40 copay | Not Covered |
| Emergency Room Care | $150 copay | $150 copay |
| Urgent Care | $25 copay | Not Covered |