What can we help you find?
< All Topics
Print

Medical Plan Summary

Medical Plan Summary

Deductible, Coinsurance, and Out-of-Pocket Maximums

Medical Mutual Open Aetna Network5000 PPO3000 PPO
Deductible (Single/Family)
– Network$5,000/$10,000$3,000/$6,000
– Non-Network$10,000/$20,000$6,000/$12,000
Coinsurance
– Network70%80%
– Non-Network50%60%
Out-of-Pocket (Includes Deductible)
– Network$7,900/$15,800$5,500/$11,000
– Non-Network$20,000/$40,000$15,000/$30,000

Services

Medical Mutual Open Aetna Network5000 PPO3000 PPO
Physician Office Visit
– Primary Care Physician$40$30
– Specialty Care Physician$75$70
Emergency Medical Care
– Urgent Care$75$70
– Emergency Care$350$300
Hospital Care
– Inpatient CoverageDeductible/CoinsuranceDeductible/Coinsurance
– Outpatient SurgeryDeductible/CoinsuranceDeductible/Coinsurance
Prescription Drugs
– Retail$10/$50/$90$10/$50/$90
– Mail Order$25/$125/$225$25/$125/$225
– Specialty Rx30% to $25030% to $250

Per Pay Rates (Semi-Monthly)

Medical Mutual Open Aetna Network5000 PPO3000 PPO
– Employee Only$62.16$95.70
– Employee + Spouse$382.58$589.03
– Employee + Child(ren)$209.63$322.76
– Family$382.58$589.03

Previous Sick and Vacation Time (FT)
Next Medical Plan Additional Resources
Table of Contents
icon

Stay In Touch!

Never miss the latest news and updates from Open Door

You have Successfully Subscribed!