Previous Page
SuperMed Select
SuperMed Select gives customers the point of service (POS) option to have their care provided, arranged, and authorized by a PCP or to self refer to another physician and receive a reduced level of
coverage. Selected family physicians, general and internal medicine practitioners, and pediatricians make up the panel of PCPs.
This managed care benefit design allows the member to receive preventive care services such as routine physicals that are normally not covered
under traditional benefit programs. The program also allows self-referral benefits for ob/gyn services as long as the member utilizes a network physician.
Medical Mutual's SuperMed Select product features a network of approximately 178 hospitals with which we have negotiated multi-year
contracts. These facilities became part of our managed care network after an extensive quality review of information regarding patient satisfaction surveys, infection rates, and morbidity/mortality levels.
Network hospitals offer our customer's rate discounts that are over and above those negotiated with Medical Mutual's Traditional
contracting hospitals. When a member uses a network hospital, eligible services are paid at the maximum level, less any deductible or co-payment
amounts, if applicable. If a non-network hospital is selected, benefits are paid at a lower level. Emergency services are not subject to non-network sanctions.
This product is available in both a two-tier and three-tier benefit design.
Two-Tier Design - In this plan the highest level of benefits is paid at the first tier when services are provided or authorized
by the member's PCP. The physician handles the overall care of the member including referrals to specialists.
Payments are reduced to the second tier of benefits when a member self refers to a network or non-network physician.
Three-Tier Design - An offshoot of the SuperMed Select two-tier plan, the three-tier design offers three choices for healthcare
and benefits received. At the first tier, benefits are the richest when members receive services from their designated PCP or from a provider referred by their PCP. Any service authorized by the
PCP will be paid at the highest level of benefits regardless of the provider's status.
Payments are reduced to the second tier of benefits when members self refer to another provider in the network.
Two-Tier Design - In this plan the highest level of benefits is paid at the first tier when services are provided or authorized
by the member's PCP. The physician handles the overall care of the member including referrals to specialists.
Payments are further reduced to a third tier when members elect to receive services from a provider outside the network.
For Sales Information: 800/245-5272
Previous Page