Tiered PPO Plan
Insurance
For 2018, the tiered feature for the PPO Plan (called the "Tiered PPO Plan" here) is available to faculty and staff who work for UMKC. 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.
2018 Tiered PPO Plan
Premiums
|
Tiered PPO Plan- 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.
|
Tiered PPO Plan- Annual deductibles, 2018 |
||||
|---|---|---|---|---|
| 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.
|
Tiered PPO Plan- Annual out-of-pocket limits, 2018 |
||||
|---|---|---|---|---|
| In-network | Out-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
|
Tiered PPO Plan- 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 Tiered PPO plan 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.
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
- 2018 PPO Plan Summary Plan Description (SPD) Available soon
- 2018 Tiered PPO Plan Summary of Benefits and Coverage (SBC)
- 2018 preferred prescription drug formulary
- 2018 specialty drug list Available soon
- Prescription FAQs
- 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 October 13, 2017.
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