How the Maroon Plan Works

How It Works

Medically Necessary Care

The plan pays a share of the covered expenses for Medically Necessary Care. Medically Necessary Care is a specific health care or Hospital service that is necessary for the treatment or management of a medical symptom or condition, and is the most efficient and economical care that can be safely provided. The fact that a physician may prescribe, order, recommend or approve a service or supply does not, of itself, make the service or supply medically necessary. The claims administrator determines whether a service is medically necessary.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.