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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.

It is a traditionally structured medical insurance plan with a broad network of providers. You pay deductibles for medical expenses and prescription drugs even if you use in-network services. This means, for most covered expenses, you’ll pay for expenses until you reach the annual deductible.

 


  2022 Retiree Health PPO  

Note: Information related to insurance coverage for COVID-19 expenses is available on the HR-702 COVID-19 Policies Q&A.

Costs

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💲 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. For more information about retiree insurance eligibility and premiums, visit the Retiree benefits overview webpage.

For additional details, see the SPD for this plan on the All Summary Plan Description (SPD) Documents webpage.

 

🩺 Covered Services

What you pay for covered services varies based on whether the provider is in-network or out-of-network:

In-Network Services
  • Preventive Care: $0
  • Primary Care: 30% coinsurance after deductible
  • Specialist Care: 30% coinsurance after deductible
  • Urgent Care: 30% coinsurance after deductible
  • Lab and X-ray: 30% coinsurance after deductible
  • Outpatient Care: 30% coinsurance after deductible
  • Inpatient Care: $325 copay per admissions, then 30% coinsurance
  • Durable medical equipment: 30% after deductible
  • Emergency room: 30% coinsurance after deductible
  • Ambulance: 30% coinsurance after deductible
Out-of-Network Services**
  • Preventive Care: 40% or more after deductible
  • Primary Care: 40% or more after deductible
  • Specialist Care: 40% or more after deductible
  • Urgent Care: 40% or more after deductible
  • Lab and X-ray: 40% or more after deductible
  • Outpatient Care: 40% or more after deductible
  • Inpatient Care: 40% or more after deductible
    • Includes maternity delivery
  • Durable medical equipment: 40% or more after deductible
  • Emergency room: 30% coinsurance after deductible
  • Ambulance: 30% coinsurance after deductible

 

**Refer to the Summary Plan Description (SPD) for additional details on allowable and eligible expenses when using an out-of- network provider.

 

➖ 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: $3,800/self; $7,600/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.

 

Making the Most of Your Plan

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📋 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.

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

 

🎗 Preventive Care and Special Health Topics

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).


Special Health Topics

Consult the following webpages for additional information on special health topics:

 

* 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 2022-04-01

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