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Retiree Health PPO Plan

The Retiree Health PPO Plan is available to retirees and their dependents who are not yet eligible for Medicare.

Visit our plan contacts page.

Looking for plan providers or health care providers?
Visit our plan contacts page for more information.


2021 Retiree Health PPO | 2020 Retiree Health PPO


  2021 Retiree Health PPO  

Monthly premiums

Your share of insurance premiums is determined by a formula that considers your age and years of service at retirement and the program under which your benefits are payable. If you are looking for an idea of what premiums would be for your particular circumstances, use the Retiree Insurance Premiums Estimator. For additional details, see the Summary Plan Description for the Retiree Health PPO Plan under the forms and guides section of this page.


Annual deductible

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

  • Medical deductible:
    • In-network: $700/self*; $1,700/family*
    • Out-of-network:  $2,100/self*; $5,100/family*
  • Rx deductible: $75/person

Out-of-pocket limit

The Retiree Health PPO Plan has two annual out-of-pocket limits: one for medical and a second for prescription drug costs.

  • Medical out-of-pocket limit:
    • In-network: $3,400/self*; $6,800/family*
    • Out-of-network**: $4,400 or more/self; $8,800 or more/family*
  • Rx out-of-pocket limit: $3,650/self; $7,300/family

Prescription drugs

  • Prescription drug: Retail:
    • In-network: Greater of (after $75 Rx deductible):
      • Formulary generic: $7 copay or 20% coinsurance
      • Formulary brand: $15 copay or 25% coinsurance
      • Non-formulary brand: $30 copay or 50% coinsurance
    • Out-of-network**: 50% coinsurance or more; minimum $30**
  • Prescription drug: Maintenance:
    • In-network: Greater of:
      • Formulary generic: $10 copay or 25% coinsurance
      • Formulary brand: $20 copay or 30% coinsurance
      • Non-formulary brand: $40 copay or 55% coinsurance
    • Out-of-network**: 50% coinsurance or more; minimum $30**
  • Prescription drug: Mail*:
    • In-network: Greater of:
      • Formulary generic: $15 or 20% coinsurance
      • Formulary brand: $30 or 25% coinsurance
      • Non-formulary brand: $60 or 50% coinsurance
    • Out-of-network**: 50% coinsurance or more; minimum $30**

* 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.


Preauthorization

In some cases, prior authorization is necessary for non-emergency use of certain facilities, diagnostic testing, and other health services before care is provided. The Retiree Health PPO Plan uses the same preauthorization list as the active-employee insurance plans.


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.

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.


  2020 Retiree Health PPO  

Monthly premiums

Your share of insurance premiums is determined by a formula that considers your age and years of service at retirement and the program under which your benefits are payable. If you are looking for an idea of what premiums would be for your particular circumstances, use the Retiree Insurance Premiums Estimator. For additional details, see the Summary Plan Description for the Retiree Health PPO Plan under the forms and guides section of this page.


Annual deductible

Retiree Health PPO Plan - Annual deductibles, 2020

  In-network Out-of-network
  Self Family Self Family
Medical $350 $850 $1,050 $3,150
Rx $75 per person covered by the plan.

Annual university contributions to health savings accounts

The university does not contribute to a health savings account (HSA) for retirees. Under the Healthy Savings Plan, which is the university’s only high-deductible health plan qualified by the IRS, you may open an HSA but the university will not make contributions to it if you are a retiree.


Out-of-pocket limit

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

Retiree Health PPO Plan - Annual out-of-pocket limits, 2020

  In-network Out-of-network
  Self Family Self Family
Medical $2,400 $4,800 $3,400 or more $6,800 or more
Rx $3,650/self; $7,300/family

Prescription drugs

Retiree Health 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 50% coinsurance or more; minimum $30**
Formulary brand $15 copay or 25% coinsurance
Non-formulary brand $30 copay or 50% coinsurance
Maintenance In-network: Greater of: Out-of-network
Formulary generic $10 or 25% coinsurance 50% coinsurance or more; minimum $30**
Formulary brand $20 or 30% coinsurance
Non-formulary brand $40 or 55% coinsurance
Mail-order* In-network: Greater of: Out-of-network
Formulary generic $15 or 20% coinsurance 50% coinsurance or more; minimum $30**
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.


Preauthorization

In some cases, prior authorization is necessary for non-emergency use of certain facilties, diagnostic testing, and other health services before care is provided. The Retiree Health PPO Plan uses the same preauthorization list as the active-employee insurance plans.


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.

* 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 2020-10-02