Go to navigation Go to content
opener
info

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.

Health and wellness discountsDiscounts

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

2019 PPO Plan with Tiered Feature  |  2018 PPO Plan with Tiered Feature


  2019 PPO Plan with Tiered Feature  

Premiums

PPO Plan with Tiered Feature - 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 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-networkOut-of-network
Medical$350/self*; $1,050/family*$700/self*; $2,100/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 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-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

PPO Plan with Tiered Feature - 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

The PPO plan with Tiered Feature makes two tiers of providers within the Choice Plus network available:

  1. 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.
  2. 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.


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.

2019 forms and guides


  2018 PPO Plan with Tiered Feature  

Premiums

PPO Plan with Tiered Feature - Monthly premiums for active employees, 2018

Coverage level

Employee cost

(tobacco-free discount**)

Employee cost

(no discount)

Self only$163$213
Self and spouse$376$426
Self and child(ren)$315$365
Self, spouse, and child(ren)$551$601

* 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.
** Earn a discount on UM System medical insurance premiums by certifying that you and family members covered by your insurance plan are tobacco free or in a cessation program. Learn more.


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, 2018

 In-networkOut-of-network
Medical$350/self*; $1,050/family*$700/self*; $2,100/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 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, 2018

 In-networkOut-of-network
Medical$3,500/self*; $7,000/family*$10,500/self*; $21,000/family*
Rx$3,650/self coverage; $7,300/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

PPO Plan with Tiered Feature - Prescription drug out-of-pocket cost, 2018

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

The PPO Plan with Tiered Feature makes two tiers of providers within the Choice Plus network available:

  1. 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.
  2. 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.


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.

* 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 October 23, 2018.