PPO Plan

Insurance

The Preferred Provider Organization (PPO) Plan is available to all benefit-eligible faculty and staff, except for those at UMKC. Employees at the UMKC business unit may select the similar PPO Plan with Kansas City Tiered Feature. 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.


  2019 PPO Plan  

Premiums

PPO Plan- Monthly premiums for active employees, 2019

Coverage levelEmployee cost
Self only$168
Self and spouse$394
Self and child(ren)$342
Self, spouse, and child(ren)$595

* 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.


Deductibles

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

PPO Plan- Annual deductibles, 2019

 In-networkOut-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*
RxRetail: $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, 2019

 In-networkOut-of-network
Medical$3,500/self*; $7,000/family*$10,500/self*; $21,000/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 costs

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.

PPO Plan- Prescription drug out-of-pocket cost, 2019

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.

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 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.

* 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 August 30, 2019.