Mayo Medical Plan (for Mayo Clinic employees) provider network

Tier (s)

1

Location of Service

Arizona

Special Notes

Mayo Clinic providers are Tier 1.

Tier (s)

1 & 2

Location of Service

Arizona

Special Notes

Tier (s)

2

Location of Service

Outside of Arizona

Special Notes

Additional providers are available through the First Health Network when you travel outside of Arizona.

Tier (s)

Location of Services

Special Notes

Other licensed providers nationwide.

Note:
You and your eligible family members will be responsible for any charges above usual, customary, and reasonable rates when you get covered services at Tier 3 out-of-network providers. Those payments won't count toward your deductible and/or out-of-pocket maximum.

However, mental and behavioral health services performed by Tier 3 out-of-network providers will be processed at Tier 2 in-network benefits under the Mayo Medical Plan. Still, out-of-network providers may bill you for costs above the non-network provider reimbursement amount.

Tier (s)

1

Location of Services

Florida

Special Notes

Mayo Clinic providers are Tier 1.

Tier (s)

1 & 2

Location of Services

Florida

Special Notes

Custom PHCS Network providers.

Tier (s)

2

Location of Services

Outside of Florida

Special Notes

Additional providers are available through the Zelis Healthcare network when you travel outside of Florida.

Tier (s)

3

Location of Services

Special Notes

Other licensed providers nationwide.

Note:
You and your eligible family members will be responsible for any charges above usual, customary, and reasonable rates when you get covered services at Tier 3 out-of-network providers. Those payments won't count toward your deductible and/or out-of-pocket maximum.

However, mental and behavioral health services performed by Tier 3 out-of-network providers will be processed at Tier 2 in-network benefits under the Mayo Medical Plan. Still, out-of-network providers may bill you for costs above the non-network provider reimbursement amount

Tier (s)

1 & 2

Location of Services

Minnesota/Wisconsin

Special Notes

Mayo Clinic providers are Tier 1.

Tier (s)

2

Location of Services

Nationwide

Special Notes

Additional providers are available through the First Health Network nationwide.

Tier (s)

3

Location of Services

Out-of-network

Special Notes

Other licensed providers nationwide.

Note: You and your eligible family members will be responsible for any charges above usual, customary, and reasonable rates when you get covered services at Tier 3 out-of-network providers. Those payments won't count toward your deductible and/or out-of-pocket maximum.

However, mental and behavioral health services performed by Tier 3 out-of-network providers will be processed at Tier 2 in-network benefits under the Mayo Medical Plan. Still, out-of-network providers may bill you for costs above the non-network provider reimbursement amount.

Tier (s)

1

Location of Services

Nationwide

Special Notes

All First Health Network providers are Tier 1.

Tier (s)

1 & 2

Location of Services

Arizona, Florida, Minnesota, or Wisconsin

Special Notes

Mayo Clinic providers are Tier 1.

Tier (s)

3

Location of Services

Out-of-network

Special Notes

Other licensed providers nationwide.

Note:
You and your eligible family members will be responsible for any charges above usual, customary, and reasonable rates when you get covered services at Tier 3 out-of-network providers. Those payments won't count toward your deductible and/or out-of-pocket maximum.

However, mental and behavioral health services performed by Tier 3 out-of-network providers will be processed at Tier 2 in-network benefits under the Mayo Medical Plan. Still, out-of-network providers may bill you for costs above the non-network provider reimbursement amount.