Tiered PPO Plan
Insurance
The Kansas City tiered feature for the PPO Plan (called the “PPO Plan with Tiered Feature” here) is available to faculty and staff who work for the UMKC business unit. Employees at other business units should refer to the PPO Plan. Retirees and their dependents are not eligible for this plan; instead, they have access to the Retiree Health PPO Plan.
Discounts
Visit the health and wellness tools and discounts webpage to maximize your convenience and savings.
2019 PPO Plan with Tiered Feature
Premiums
|
PPO Plan with Tiered Feature - Monthly premiums for active employees, 2019 | ||
|---|---|---|
| Coverage level | Employee 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 Tiered PPO Plan has two deductibles: one for medical and a second for prescription drug costs.
|
PPO Plan with Tiered Feature - Annual deductibles, 2019 | ||||
|---|---|---|---|---|
| In-network | Out-of-network | |||
| Medical | $350/self*; $1,050/family* | $700/self*; $2,100/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 Tiered PPO Plan has two out-of-pocket limits: one for medical and a second for prescription drug costs.
|
PPO Plan with Tiered Feature - Annual out-of-pocket limits, 2019 | ||||
|---|---|---|---|---|
| In-network | Out-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 with Tiered Feature - Prescription drug out-of-pocket cost, 2019 | ||||
|---|---|---|---|---|
Retail | In-network: Greater of | 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 | 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
The PPO plan with Tiered Feature makes two tiers of providers within the Choice Plus network available:
- Tier 1 includes Premium Care Physicians. These providers are recognized by UHC as having a rating of two hearts(♥♥) because of their high-quality, cost-effective care.
- Tier 2 (or non-designated) includes certain types of specialists; Quality Care Physicians, or providers recognized by UHC as having a rating of one heart; and providers who are unrated or do not meet the criteria for a designation.
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. 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.
- UHC's introduction to the tiered PPO feature
- UHC's save money by using freestanding facilities
- UHC's list of specialties covered by tiered PPO feature
- UHC's information about choosing Tier 1 doctors
- 2019 PPO Plan Summary Plan Description (SPD)
- 2019 Tiered PPO Plan Summary of Benefits and Coverage (SBC)
- 2019 preferred prescription drug formulary
- 2019 specialty drug list
- Prescription FAQs
- Special health topics (such as behavioral health, diabetes and preventive care)
- Full list of forms and guides about medical insurance …
* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.
Reviewed July 26, 2019.
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