The Key to Providing Cost Effective Health Insurance Plans
The Maximum Allowable Charge or "MAC" is central to MEGA's Consumer Guided Health Insurance plans. It is our most powerful tool to encourage more involvement by customers in decisions about their health care. By making MAC the central part of our plans, we are able to eliminate network restrictions and lower premiums.
MAC is the maximum amount the plan pays providers and hospitals for any covered service. Discounted providers are made available to help customers stay within the MAC. With MAC, customers learn the true cost of health care, and become active participants in spending their own health care dollars. By making MAC a part of their plan, our customers can easily comparison shop between providers - and make the choices that reflect the best economic and health sense for them. The MAC does not cover the full amount of provider charges in all instances.
We urge our customers to call MEGA's Customer Care at 1-800-855-5540 or check the web site before seeking care to obtain information about which providers are "In the Green". This is our simple expression (depicted by colored dots) for providers whose charges are likely to be at or below the MAC. In order to stay "In The Green", customers need to know in advance how one health care provider compares to another, generally what care will cost, and if there is likely to be any out-of-pocket responsibility with one provider versus another. Our Customer Care specialists and web site will provide the answers.
Of course, customers can choose any provider they like - but if that provider charges above the MAC, services may cost more than the plan pays and the customer will owe the difference.
The MAC applies to every service the plan covers - from check-ups to surgery. MEGA pays up to the MAC amount for any covered service. The MAC stays the same regardless of which provider a customer chooses, which means the choice to pay more or less is left up to you. Only charges at or below the MAC count toward paying off a customer's annual deductible requirements and coinsurance maximum. We firmly believe that transparency in pricing and flexibility in plans are two of the keys to keeping health care affordable for small businesses and individuals.
The MAC applies to MEGA's Select Plans where available. Selecting providers "In the Green" is not a guarantee that you will stay within the MAC for a particular service. Providers change their charges from time to time. When charges exceed the MAC, you will be responsible for the difference. To confirm that a provider's charges will be at or below the MAC, you should speak with your provider before receiving services.
