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PPO Plan

Insurance

The Preferred Provider Organization (PPO) Plan is available to all benefit-eligible faculty and staff, except for those at UMKC. UMKC employees may select the similar Tiered PPO Plan. Retirees are not eligible for this plan; instead, retirees have access to the Retiree Health PPO Plan.

Health and wellness discountsDiscounts

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

2018 PPO Plan  |  2017 PPO Plan


  2018 PPO Plan  

Premiums

PPO Plan- Monthly premiums for active employees, 2018

Coverage level Employee cost
(tobacco-free discount**)
Employee cost
(no discount)
Self only $163 $213
Self and spouse $376 $426
Self and child(ren) $315 $365
Self, spouse, and child(ren) $551 $601

* Premiums for retirees vary according to a formula based on years of service and other factors. For an idea of what premiums would be for your particular circumstances, use the Retiree Insurance Premiums Estimator.
** 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 PPO Plan has two deductibles: one for medical and a second for prescription drug costs.

PPO Plan- Annual deductibles, 2018

  In-network Out-of-network
Medical: Rolla $350/self*; $1,050/family* $700/self*; $2,100/family*
Medical: Columbia and St. Louis $500/self*; $1,500/family* $1,000/self*; $3,000/family*
Rx Retail: $75/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 PPO Plan has two out-of-pocket limits: one for medical and a second for prescription drug costs.

PPO Plan- Annual out-of-pocket limits, 2018

  In-network Out-of-network
Medical $3,500/self*; $7,000/family* $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 costs

PPO Plan- Prescription drug out-of-pocket cost, 2018

Retail
($75 deductible)
In-network: Greater of
(after 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 to UHC website).


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 PPO Plan. In fact, the University is not legally allowed to do so, because HSAs are allowed only in conjunction with an-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 PPO Plan  

Premiums

PPO 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 $151 $201 $594 $544 $745
Self and spouse $352 $402 $1,138 $1,088 $1,490
Self and child(ren) $292 $342 $975 $925 $1,267
Self, spouse, and child(ren) $513 $563 $1,573 $1,523 $2,086

* Premiums for retirees vary according to a formula based on years of service and other factors. For an idea of what premiums would be for your particular circumstances, use the Retiree Insurance Premiums Estimator.
** 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 PPO Plan has two deductibles: one for medical and a second for prescription drug costs.

PPO Plan- Annual deductibles, 2017

  In-network Out-of-network
  Self* Family* Self* Family*
Medical: Kansas City and Rolla $350 $1,050 $700 $2,100
Medical: Columbia and St. Louis $500 $1,500 $1,000 $3,000
Rx Retail: $75/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 PPO Plan has two out-of-pocket limits: one for medical and a second for prescription drug costs.

PPO 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 costs

PPO Plan- Prescription drug out-of-pocket cost, 2017

Retail ($75 deductible) In-network: Greater of (after 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 PPO Plan. In fact, the university is not legally allowed to do so, because HSAs are allowed only in conjunction with an-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 October 13, 2017.