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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. 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.

Discounts

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



  2020 PPO Plan  

Premiums

PPO Plan- Monthly premiums for active employees, 2020

Coverage level Employee cost
Self only $171
Self and spouse $411
Self and child(ren) $366
Self, spouse, and child(ren) $629

Deductibles

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

PPO Plan- Annual deductibles, 2020

  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 PPO Plan and Custom Network Plan than the Healthy Savings 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, 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 PPO Plan and Custom Network Plan than for 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 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, 2020

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).


Consider a Flexible Spending Account

If you enroll in the PPO 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

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

Many documents on this webpage require Adobe Acrobat. A free reader is available to everyone. Read more about PDFs.

Reviewed 2020-03-16