Schedule of Benefits & Plan Design MEC HP3

Schedule of Benefits & Plan Design MEC HP3. The following table represents the type of medical services currently covered under the MEC HP3 Plan as well as the permitted interval and any requirements of such medical services. Note that some requirements may be defined by the benefit itself, such as cholesterol abnormalities screening: men 35 and older. Only men aged 35 or older may access such Benefits by fiat of the benefit itself. What You Will Pay Out-of-Network Medical Service Network Provider Limitations & Exceptions Provider (You (You will pay the will pay the least). most). Doctor's O ce $25 Member Copay Not Covered Limit of 3 doctor visits per plan year. Visit You may have to pay for services that aren't preventive. Ask your provider if Preventive and the services you need are preventive. 100% by Plan1 Not Covered Wellness Services Then check what your plan will pay for. See Schedule of Wellness and Preventive Services below. 1. No cost to member. Supplemental Hospital Benefit The following table represents the supplemental hospital benefit covered under the MEC HP3.

Risk-reducing medications, such as tamoxifen or raloxifene forwomen who are at increased risk for breast cancer and at low risk for adverse medication effects.

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