On the Medical Mutual plans, your medical premium includes prescription and vision benefits. The 85/60 health insurance plan offers a lower deductible, but a higher monthly premium. The plan covers preventive annual exams, immunizations, and preventive screenings at no cost to the employee. Other in-network inpatient, outpatient, and diagnostic services are covered at 85% after the deductible is satisfied. Out-of-network coverage for these services is covered at 60% after the deductible has been satisfied.
With the 85/60 plan, preventive care is covered at 100% with in-network providers. There is a $300 dollar deductible for single coverage and $600 deductible for family coverage for non-preventive services. After the initial deductible of $300 is met, then this plan will begin to cover services at 85% of the costs for in-network services and 60% costs for out-of-network services. Examples of preventive care services (PDF) are annual exams, immunizations, and preventive screenings.
You will need to continue paying 15% of the health care services until you meet the annual co-insurance maximum. The co-insurance maximum is $1,500 for single coverage or $3,000 for family coverage when using in-network providers. Also, with the 85/60 plan, there is a $15 copay for a primary care physician and a $30 copay for a specialist. The copays do not go towards your deductibles.
You can enroll in a Flexible Spending Account (FSA) to use pre-tax dollars to pay for eligible healthcare expenses incurred by you or your eligible dependents. Dependent Care FSAs allow you to use pre-tax dollars to pay for DAYCARE expenses for dependents up to the age of 13 or for elderly care. Visit our FSA and HSA web page for more information.