Health Insurance

Website: www.medmutual.com

• Network Name (Traditional/PPO plans): SuperMed Plus
• One Level of Traditional Coverage
  • $250 deductible for individual/$500 deductible for family
  • $1,000 out-of-pocket max for individual/$2,000 max for family
  • No lifetime maximum on benefits
  • No co-pays
  • Once the deductible is satisfied, employee is responsible for 10% of the charges (for in-network providers) up to the maximum level for individual and/or family coverage
  • If an out-of-network provider is used, the deductible increases to $500/person and $1,000/family. The out-of-pocket max increases to $2,000 person/$4,000 family
  • If you use an out-of-network provider, Medical Mutual will send the reimbursement to the employee. Employee is then responsible for forwarding payment to the provider
  • Any amount paid towards the deductible in October, November and/or December in any year is applied to the next calendar year (amount paid towards out-of-pocket max does not carry over)
• Preventive Care Services covered at 100% (deductible does not apply)
  • Routine physical exams
  • Pap tests
  • Prostrate screening
  • Immunizations (if done at pharmacy, must pay in full up front and file a paper claim)
  • Newborn care
  • Well child Care
  • Routine GYN exam
  • Colon cancer screening
• LabCorp and Quest are network providers for laboratory services
• Don’t need to obtain a referral to go to a specialist
• Separate ID cards will be issued to each employee for Medical/Rx, Dental and Vision. ID Cards are issued in pairs. Additional cards can be requested online or by calling customer support. ID cards will only list the employee
• Open enrollment for NC State will occur between October and December each year and will be effective January 1. Any changes to coverage (except for qualifying events) can only be made during this time
• 24/7 NurseLine (1-888-912-0636) is a source for health information and support. Gives you access through one toll-free telephone number to a wide range of health and well-being information such as:
  • Routine illness
  • Minor injuries
  • General health information
  • Help finding a doctor
  • Information on medications
  • Spousal Waiver- working spouse is not eligible for primary coverage with COG if they have coverage through their own employer’s health plan
• Dependent age limits:
  • Up to age 26, dependents will be eligible to enroll in medical and Rx even if they do not live at home, are not a dependent on the employee’s tax return, are not a student, have coverage available through employment and can be married or unmarried
  • For dental and vision coverage only, dependent children are covered to the end of the month of their 19th birthday or the end of the month of their 26th birthday if the dependent is a full-time student (12 credits for undergrad; 9 credits for grad students)
  • Between age 26 and 28, dependents can be covered at an extra cost to employees.
  • It is the responsibility of the employee to notify Human Resources when a dependent ceases to be eligible. Claims incurred and processed when a dependent is not eligible will totally become the responsibility of the employee