Page 9 - 2018 MDT Benefits & Notices

Member Driven Technologies (MDT) 2018

Medical Coverage

MDT offers an HRA PPO medical plan to its eligible employees.

PPO Option

• The PPO plan is offered through Blue Cross Blue
Shield of Michigan (BCBSM). “PPO” stands for
Preferred Provider Organization.

• Approximately 95% of the US population is within
reach of a BCBS PPO provider.

• You do not need to choose a Primary Care Physician
(PCP) with a PPO – you may see any provider you
want to see, even a specialist.

• You receive the most benefits when you receive care from participating BCBS PPO providers. You
may see a non-BCBS PPO provider, but your benefits will be reduced and you’ll pay more out of
pocket.

• For a list of BCBSM PPO providers visit www.bcbsm.com or call 800.637.2227

• For a list of BCBS PPO providers outside of the MI visit www.bcbs.com & click Find a Doctor or
Hospital

Additional Plan Information

The medical plan does not have a pre-existing condition limitation.

The plan has a deductible, which is the amount you must pay before the plan begins paying for most
routine or emergency medical care.
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Preventive services are covered at 100% in network with no deductible on both plans. The benefit
summaries on the following pages show an abbreviated list of preventive benefits we cover.

The plan has an out-of-pocket maximum. Once you have spent this out-of-pocket amount on coinsurance
following your deductible, the plan will pay 100% of any medical charge which would otherwise have a
coinsurance for the remainder of the plan year. The plan Summary of Benefits Coverage (SBC) explains
these out of pocket maximum and can be found in this booklet.

Waiver of Medical Coverage – Opt Out Option

You may elect to waive medical coverage from MDT if you have and can provide proof of existing coverage
from another source (spouse, parent, etc.). When proof of coverage is provided to Human Resources and
validated, you will be eligible to enroll in the dental plan. The Opt Out Option provides a monetary subsidy
to the eligible employee. Check with Human Resources for the current amount of the benefit.

Should you suffer a HIPAA status change event, you may be added to MDT’s medical plan mid-year only
if notification is given to Human Resources no later than 31 days of the event.

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