Page 10 - MM365+

Key Words to Know:
Coinsurance: Percentage of the charge that your plan will pay, typically after you have met the deductible
Copay: An amount you pay for a covered service each time you use that service, which usually does not apply toward the deductible
Deductible: The amount you pay before the plan begins to pay
Out-of-Pocket Costs: Expenses you pay yourself, such as deductibles, copays, and the remaining amounts
after plan coinsurance is paid
Out-of-Pocket Maximum: The maximum amount you pay for covered services in a year (you may need to pay additional amounts if coverage is received from an out-of-network provider)
Using In-Network Providers
You’ll save money when receiving care from an in-network provider. To access a list of in-network providers, click on the link provided on the Mercer Marketplace 365+ enrollment site. Using an out-of-network provider could result in a higher out-of-pocket cost.
Prescription Drug Coverage
Your prescription drug coverage depends on the medical coverage level you choose. Medications are grouped into tiers, which determine your portion of the drug cost.
TIER[*]
YOU PAY
WHAT’S COVERED
1
Lowest Cost Sharing
Most Generic Prescription Drugs
Generic drugs that are equivalent to a brand product in dosage form, strength, quality and intended use
2
Second-Lowest Cost Sharing
Preferred Brand Name Drugs
Drugs sold under specific trade names that are favorably priced by the pharmacy plan
3
Highest Cost Sharing
Non-Preferred Brand Name Drugs
Drugs sold under specific trade names that have a more cost-effective alternative on Tier 1 or Tier 2
[4]
[Specialty Drugs
Specialty medications treat rare or complex conditions and are typically higher cost medications. Most will require pre-authorization before your plan will help pay for them, and some may require you to fill the prescription at a specialty pharmacy.]
[5]
[*Some plans have additional prescription tiers. See plan documents for details.]
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Medical and
Prescription Drug Coverage