Program Features                                                     Medical Care Programs
 

MANAGED MEDICAL CARE PROGRAM
(MMCP)
In-Network (Services
provided by a BlueCross
and/or BlueShield Preferred Provider)

 Out-of-Network (Services
not provided by a Blue Cross and/ or BlueShield Preferred
Provider)		 COMPREHENSIVE
HEALTH CARE BENEFIT

(CHCB)
Annual Deductible None
$100 Individual
$300 Family		 $100 Individual
$300 Family
Annual Out-of-Pocket Maximum $0
$1,500 Individual*
$3,000 Family*		 $1,500 Individual*
$3,000 Family*
Lifetime Benefit Maximum Unlimited $1,000,000 $1,000,000
Coordination of Benefits Yes Yes Yes
Medical Management (for-merly known as Patient Advocate) Penalty Does not apply Applies Applies

 

Benefits
Inpatient Hospital MMCP pays 100% MMCP pays 75%** CHCB pays 85%**
Outpatient Hospital MMCP pays 100% MMCP pays 75%** CHCB pays 85%**
Same-day Surgery MMCP pays 100% MMCP pays 75%** CHCB pays 85%**
Emergency Care Facility You pay $30 pervisit*** MMCP pays 75%

CHCB pays 85%
Skilled Nursing Facility MMCP pays 100% up to 60 days per calendar year MMCP pays 75%** up to 60 days per calendar year

CHCB pays 85%
up to 31 days per
hospitalization**
Physician and Other Health Care Provider Services      
· Office Visits You pay $15 per visit MMCP pays 75%

CHCB pays 85%
· Routine Physicals! Preventive Care You pay $15 per visit Not covered Not covered
· Well Child Care You pay $15 per visit

Not covered

 Not covered
· Hospital Visits MMCP pays 100% MMCP pays 75%** CHCB pays 85%**
· Diagnostic Tests MMCP pays 100%            MMCP pays 75%** CHCB pays 85%**
· Surgery/Anesthesia MMCP pays 100% MMCP pays 75%** CHCB pays 85%**
Hospice Care MMCP pays 100% MMCP pays 75%** Up to $3,000** CHCB pays 85% Up to $3,000**
Home Health Care MMCP pays 100% MMCP pays 75% up to 40 visits per year** CHCB pays 85%**

* This excludes CHCB deductibles, or co-payments made for offiice or emergency care facility visits under MMCP or co-payments for prescription drugs under MPSB.
** Medical Management (formerly known as Patient Advocate) must approve care or your benefit payment will be reduced by 20%.
$15 is rebated to you if the emergency care facility visit was determined to be a true emergency. If it was determined not to be a true emergency, MMCP pays 75%.