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Custom Network Plan

Insurance

There are two versions of the Custom Network Plan for benefit-eligible faculty and staff: one for those who live and/or work in the Columbia area (coverage map (PDF, 109KB)) and another for those who live and/or work in the St. Louis area (coverage map (PDF, 140KB)). See the eligibility section of this webpage for details. Retirees are not eligible for the Custom Network Plan.

Discounts

Visit the health and wellness tools and discounts webpage to maximize your convenience and savings.


Eligibility

If you are a benefit-eligible faculty or staff member with an home address or official business unit in an eligible region around Columbia or St. Louis, the Custom Network Plan is available to you. Counties are different for the Columbia and St. Louis plans, as follows:

Columbia: Audrain, Boone, Callaway, Cole, Cooper, Howard, Moniteau, Osage, and Randolph. See the coverage map (PDF, 109KB).

St. Louis: There are eligible counties in both Missouri and Illinois. In Missouri: Franklin, Gasconade, Jefferson, Lincoln, Montgomery, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, and Washington. In Illinois: Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Pike, Randolph, and St. Clair. See the coverage map (PDF, 140KB)

You may be eligible for both the Custom Network Plan in Columbia and the Custom Network Plan in St. Louis (i.e., your official business unit is located in an eligible Columbia-only county but your home address is in an eligible St. Louis-area county, or vice versa). In this case, you will have the option to enroll in either of the two insurance plans. Please note, however, that these plans have access to different networks of medical care providers. You will only have in-network access to those providers associated with the particular plan in which you choose to enroll.


2020 Custom Network Plan | 2019 Custom Network Plan


  2020 Custom Network Plan  

Premiums

Custom Network Plan- Monthly premiums for active employees, 2020

Coverage level Employee cost
Self only $83
Self and spouse $231
Self and child(ren) $200
Self, spouse, and child(ren) $365

Deductibles

The Custom Network Plan has two deductibles: one for medical and a second for prescription drug costs.

Custom Network Plan- Annual deductibles, 2020

  In-network Out-of-network
Medical $0/self*; $0/family* $500/self*; $1,500/family*
Rx Retail: $50/person; Mail-order: $0/person

* Considerations for “self” and “family” are different for the Custom Network Plan and PPO Plan than the Healthy Savings Plan. Visit the glossary for details.


Out-of-pocket limits

The Custom Network Plan has two out-of-pocket limits: one for medical and a second for prescription drug costs.

Custom Network Plan- Annual out-of-pocket limits, 2020

  In-network Out-of-network**
Medical $3,500/self*; $7,000/family* $10,500 or more/self*; $21,000 or more/family*
Rx $4,650/self coverage; $9,300/family coverage

* Considerations for “self” and “family” are different for the Custom Network Plan and PPO Plan than the Healthy Savings Plan . Visit the glossary for details.
**Please refer to the Summary Plan Description (SPD) for additional details on allowable/eligible expenses when using an out-of-network provider.


Prescription drug

To estimate prescription costs, visit Express Script's prescription cost estimator tool (exit UM System site) for UM System medical plans. Select the plan year and health plan you wish to review; then, select "price a medicine" and type in the medicine's name. You will be prompted to select the strength, form, quantity and frequency for the prescription to estimate the cost covered by the plan and the cost to you.

Custom Network Plan- Prescription drug out-of-pocket costs, 2020

Retail ($50 deductible) In-network: Greater of (after Rx deductible): Out-of-network
Formulary generic $7 copay or 20% coinsurance $30 copay or 50% network costs or more after deductible**
Formulary brand $15 copay or 25% coinsurance
Non-formulary brand $30 copay or 50% coinsurance
Mail-order ($0 deductible)* In-network: Greater of: Out-of-network
Formulary generic $15 or 20% coinsurance $30 copay or 50% network costs or more after deductible**
Formulary brand $30 or 25% coinsurance
Non-formulary brand $60 or 50% coinsurance

* 90-day fill/refill at Mizzou pharmacies at same cost as mail-order.
** Member will pay difference between the non-participating and participating pharmacy charge.


Network providers

You may choose to visit either in-network or out-of-network doctors and other providers. Your costs will be lower, however, when you select in-network providers. Provider directories may be accessed on the plan contacts webpage.

Virtual visits are also available to you. Virtual visits let you see and talk to a doctor from your mobile device or computer without an appointment, any time. Visit the virtual visits webpage to learn more.


Preventive care

Many health plans include preventive care services, such as various screenings, vaccinations, and well-woman visits, at no out-of pocket cost. Read about women's preventive healthcare or learn more about UHC's preventive care guidelines (exit UM System site).


Consider a Flexible Spending Account

If you enroll in the Custom Network plan, you may also want to consider enrolling in a Health Care Flexible Spending Account (FSA), an account that allows you to set aside pre-tax dollars to pay for out-of-pocket medical expenses. Visit the Understanding your flexible spending account webpage to learn more.

Forms and guides


  2019 Custom Network Plan  

Premiums

Custom Network Plan- Monthly premiums for active employees, 2019

Coverage level Employee cost
Self only $82
Self and spouse $222
Self and child(ren) $189
Self, spouse, and child(ren) $346

Deductibles

The Custom Network Plan has two deductibles: one for medical and a second for prescription drug costs.

Custom Network Plan- Annual deductibles, 2019

  In-network Out-of-network
Medical $0/self*; $0/family* $500/self*; $1,500/family*
Rx Retail: $50/person; Mail-order: $0/person

* Considerations for “self” and “family” are different for the Healthy Savings Plan than for the Custom Network Plan and PPO Plan. Visit the glossary for details.


Out-of-pocket limits

The Custom Network Plan has two out-of-pocket limits: one for medical and a second for prescription drug costs.

Custom Network Plan- Annual out-of-pocket limits, 2019

  In-network Out-of-network
Medical $3,500/self*; $7,000/family* $10,500 or more/self*; $21,000 or more/family*
Rx $4,400/self coverage; $8,800/family coverage

* Considerations for “self” and “family” are different for the Healthy Savings Plan than for the Custom Network Plan and PPO Plan. Visit the glossary for details.


Prescription drug

To estimate prescription costs, visit Express Script's prescription cost estimator tool (exit UM System site) for UM System medical plans. Select the plan year and health plan you wish to review; then, select "price a medicine" and type in the medicine's name. You will be prompted to select the strength, form, quantity and frequency for the prescription to estimate the cost covered by the plan and the cost to you.

Custom Network Plan- Prescription drug out-of-pocket costs, 2019

Retail ($50 deductible) In-network: Greater of (after Rx deductible): Out-of-network
Formulary generic $7 copay or 20% coinsurance $30 copay or 50% network costs after deductible**
Formulary brand $15 copay or 25% coinsurance
Non-formulary brand $30 copay or 50% coinsurance
Mail-order ($0 deductible)* In-network: Greater of: Out-of-network
Formulary generic $15 or 20% coinsurance $30 copay or 50% network costs after deductible**
Formulary brand $30 or 25% coinsurance
Non-formulary brand $60 or 50% coinsurance

* 90-day fill/refill at Mizzou pharmacies at same cost as mail-order.
** Member will pay difference between the non-participating and participating pharmacy charge.


Network providers

You may choose to visit either in-network or out-of-network doctors and other providers. Your costs will be lower, however, when you select in-network providers. Provider directories may be accessed on the plan contacts webpage.

Virtual visits are also available to you. Virtual visits let you see and talk to a doctor from your mobile device or computer without an appointment, any time. Visit the virtual visits webpage to learn more.


Preventive care

Many health plans include preventive care services, such as various screenings, vaccinations, and well-woman visits, at no out-of pocket cost. Read about women's preventive healthcare or learn more about UHC's preventive care guidelines (exit UM System site).


Annual University contribution to Health Savings Account

The University does not contribute to a Health Savings Account (HSA) for faculty or staff enrolled in the Custom Network Plan. In fact, the University is not legally allowed to do so, because HSAs are allowed only in conjunction with a IRS-qualified high-deductible health plan. The University's qualified plan is the Healthy Savings Plan.

* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.

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Reviewed 2019-10-15