Medical Benefits

MTC Holding Corporation pays 100% of the premium for employee only and employee + child(ren) coverage. Costs are deducted on a semi-monthly basis. To find a doctor in the Preferred Care Blue Network, please visit www.bluekc.com. Plan documents can be found below.

	In-Network	Out-of-Network
Deductible (Individual/Family)	$750/$1,500	$1,500/$3,000
Out-of-Pocket Max (Individual/Family)	$3,500/$7,000	$10,500/$21,000
Member Coinsurance	10%	30%
Primary Care Visit	$25 Copay	Deductible + 30%
Specialist Visit	$50 Copay	Deductible + 30%
Preventive Care	Covered at 100%	Deductible + 30%
Urgent Care	$50 Copay	Deductible + 30%
Inpatient Surgery	Deductible + 10%	Deductible + 30%
Outpatient Surgery	Deductible + 10%	Deductible + 30%
Emergency Room	$300 Copay + Deductible + 10% (Copay Waived if Admitted)	$300 Copay + Deductible + 10% (Copay Waived if Admitted)
Retail Prescriptions
Tier 1	$20 Copay	Copay + 50%
Tier 2	$35 Copay	Copay + 50%
Tier 3	$55 Copay	Copay + 50%
Mail Order Prescriptions
Tier 1	$40 Copay	Copay + 50%
Tier 2	$70 Copay	Copay + 50%
Tier 3	$110 Copay	Copay + 50%

	Employee Per Pay Period Cost	MTC Per Pay Period Cost
Employee Only	$0	$621.56
Employee + Spouse	$270	$1,063.22
Employee + Child(ren)	$0	$1,237.99
Employee + Family	$270	$1,679.54

Downloads

Summary of Benefits

Wellness Benefit

How to File a Wellness Claim

Participation in this plan allows you to open and contribute to a Health Savings Account (HSA).

	In-Network	Out-of-Network
Deductible (Individual/Family)	$3,400/$6,800	$6,600/$13,200
Out-of-Pocket Max (Individual/Family)	$3,400/$6,800	$8,100/$16,200
Member Coinsurance	0%	20%
Primary Care Visit	Deductible	Deductible + 20%
Specialist Visit	Deductible	Deductible + 20%
Preventive Care	Covered at 100%	Deductible + 20%
Urgent Care	Deductible	Deductible + 20%
Inpatient Surgery	Deductible	Deductible + 20%
Outpatient Surgery	Deductible	Deductible + 20%
Emergency Room	Deductible	Deductible
Retail Prescriptions
Tier 1	Deductible	Deductible + Copay + 50%
Tier 2	Deductible	Deductible + Copay + 50%
Tier 3	Deductible	Deductible + Copay + 50%
Mail Order Prescriptions
Tier 1	Deductible	Deductible + Copay + 50%
Tier 2	Deductible	Deductible + Copay + 50%
Tier 3	Deductible	Deductible + Copay + 50%