MCHA Policy of Hospital, Surgical and Medical Insurance Benefits:

·        $500 deductible plan options

·        $1000 deductible plan options

·        $2000 deductible plan options 

After payment of the deductible, coverage is provided at 80% of the allowed amount for eligible services received from In-Network providers.  Payment of the remaining 20% charges is a coinsurance responsibility of the insured.  Once $3000 of eligible out-of-pocket expenses has been satisfied in a calendar year, MCHA pays 100% of the allowed amount for eligible services to the end of the calendar year, to a lifetime maximum benefit of $2,800,000.

You have the option to utilize Out-of-Network providers, however, the benefit and payment percentage will generally be less than stated above. 

Benefits generally include charges for eligible services when ordered by a physician.  Eligible services include: 

• Professional Service
• Prescription Drugs and Pharmacy Services
• Mail Service Prescription Drug Program
• Hospital Services
• Ambulance Services
• Home Health Care
• Outpatient Rehabilitation
• Mental Health
• Substance Abuse
• Durable Medical Equipment and Prosthetics
• Miscellaneous Medical supplies
• Organ and Bone Marrow Transplant Services
• Infertility Services
• Reconstructive and Restorative Surgery
• Skilled Nursing Facility Services
• Hospice Services
• Temporomandibular Joint Disorder (TMJ)
• Medical-Related Dental Services
• Emergency Services

Medicare Supplement Plans:

·        Basic Medicare Supplement (no Rx coverage, optional riders available)

·        Extended Basic Medicare Supplement (with Rx coverage)

For the Basic Medicare Supplement plan (providing the care is Medicare eligible and the member has met his/her Medicare deductibles) MCHA pays the 20% not covered by Medicare up to the allowed amount.  The insured is responsible for any amount in excess of the allowed amount and for any ineligible service.  Optional additional riders are available. For the Extended Basic Medicare Supplement plan, coverage is 100% of covered expenses in any calendar year after $1,000 of out-of-pocket expenses are paid by the insured person.  Prescription medications are eligible for coverage at 80% of the allowed amount for formulary drugs.

Important Information on Pre-existing Conditions: 

For all MCHA policies, no benefits are payable during the first six months of coverage for expenses for any preexisting condition, injury, illness or other physical or mental condition that was diagnosed, treated or evaluated during the 90 days preceding the effective date of coverage.  However, Minnesota State law does provide some exceptions to the preexisting condition limitation.  In order to determine if you may be eligible for a waiver, you must requests a waiver of the preexisting condition limitation by completing the applicable section of the MCHA application.