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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.

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

2018 Custom Network Plan  |  2017 Custom Network Plan


  2018 Custom Network Plan  

Eligibility

In order to be eligible to enroll in the Custom Network Plan, you must be a benefit-eligible faculty or staff member who lives or works in an eligible county. 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)

It's possible that you may be eligible for both the Custom Network Plan-Columbia and the Custom Network Plan-St. Louis (i.e., you work in an eligible county near Columbia but live in an eligible county near St. Louis, 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.


Premiums

Custom Network Plan- Monthly premiums for active employees, 2018

Coverage level Employee cost
(tobacco-free discount**)
Employee cost
(no discount)
Self only $78 $128
Self and spouse $206 $256
Self and child(ren) $169 $219
Self, spouse, and child(ren) $311 $361

** Earn a discount on UM System medical insurance premiums by certifying that you and family members covered by your insurance plan are tobacco free or in a cessation program. Learn more.


Deductibles

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

Custom Network Plan- Annual deductibles, 2018

  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, 2018

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

Custom Network Plan- Prescription drug out-of-pocket costs, 2018

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.


Preventive care

Many health plans include preventive care services, such as various screenings, vaccinations, and well-woman visits, at no out-of pocket cost. 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.

2018 forms and guides

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



  2017 Custom Network Plan  

Eligibility

In order to be eligible to enroll in the Custom Network Plan, you must be a benefit-eligible faculty or staff member who lives or works in an eligible county. 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)

It's possible that you may be eligible for both the Custom Network Plan-Columbia and the Custom Network Plan-St. Louis (i.e., you work in an eligible county near Columbia but live in an eligible county near St. Louis, 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.

Premiums

Custom Network Plan- Monthly premiums for active employees, 2017

  Employee cost UM cost  
Coverage level (tobacco-free discount*) (no discount) (tobacco-free discount*)  (no discount) Total
Self only $73 $123 $441 $391 $514
Self and spouse $196 $246 $832 $782 $1,028
Self and child(ren) $159 $209 $715 $665 $874
Self, spouse, and child(ren) $294 $344 $1,145 $1,095 $1,439

* Earn a discount on UM System medical insurance premiums by certifying that you and family members covered by your insurance plan are tobacco free or in a cessation program. Learn more.

Deductibles

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

Custom Network Plan- Annual deductibles, 2017

  In-network Out-of-network
  Self* Family* Self* Family*
Medical $0 $0 $500 $1,500
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, 2017

  In-network Out-of-network
  Self* Family* Self* Family*
Medical $3,500 $7,000 $10,500 $21,000
Rx $3,650/self coverage; $7,300/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

Custom Network Plan- Prescription drug out-of-pocket cost, 2017

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.

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 preventive care guidelines.

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.

2017 forms and guides

* 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 September 25, 2017.