Total Rewards frequently asked questions

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Did retiree insurance change for employees who retired prior to 1/1/18?

Changes to UM System retiree insurance eligibility and subsidies, effective 1/1/2018, have no effect on employees who retired prior to 1/1/2018. These retirees, as well as their spouses and other dependents, who are enrolled in UM’s insurance plan(s) will:

  • Retain their UM insurance coverage—including medical, dental, life, and vision insurance.
  • Retain the current subsidy from UM—including subsidies for spouses and other dependents.

For a list of current plans available to retirees—including dental, vision, and life—visit the retiree benefits overview on the Total Rewards website.

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How do changes to retiree insurance, effective 1/1/18, affect current faculty and staff?

Under the changes, employees’ eligibility for UM System retiree insurance benefits, as well as their eligibility for a UM System premium subsidy, is different depending on their age and years of service. Visit the Retiree benefits overview webpage for general information on eligibility.

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What research was conducted to support the new structure of retiree insurance, effective 1/1/18?

The Retiree Medical Study provided the research on which the Total Rewards Advisory Committee (TRAC) made its deliberations when developing its retiree insurance recommendations, which have since been approved and implemented. For more information, access the Retiree Medical Study webpage or the Retiree Insurance Eligibility webpage.

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When deciding which Access Category I am in, does UM round my age and years of service?

Effective January 1, 2018, employee’s eligibility for the university’s retiree insurance plans will change. Eligibility will differ based on whether an employee falls into Access Category A, B, C, or D. The Access Category you are assigned to is based on whole numbers; partial years are not counted. For example, if you are age 50.5 and have 5.5 years of service, you drop the half a year on each and add 50 and 5. In this example, the calculation is 50 + 5 = 55. It’s not 50.5 + 5.5 = 56.

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Do changes to retiree insurance affect all retiree insurance benefits, or just medical plans?

The changes in eligibility pertain to all retiree insurance plans including life insurance plans.  Changes in subsidies pertain only medical and dental plans; all other plans are unsubsidized both for current faculty and staff and eligible retirees.

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How does an employee become eligible for UM retiree insurance right now?

Employees who retire on or after January 1, 2018, are eligible for retiree health insurance if they: were employed in a UM System benefit-eligible position on December 31, 2017; reached at least five years of vesting service as of December 31, 2017; and reach at least 60 years old by retirement date; and accrue at least 20 years of creditable service to the UM System by their retirement date.

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If I have a sick or vacation time accrued, what happens to it when I retire?

When you retire, you will receive day-for-day service credit for accrued sick leave, and there is no cap on sick leave accruals. 

For unused accrued vacation time, you will receive service and salary credit. Unused accrued vacation time is paid out over time at retirement; there are caps on vacation accrual based on your accrual rate. 

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Who are the in-network providers for my medical insurance plan with UnitedHealthcare?

The list of in-network providers for each medical plan is available online from UnitedHealthcare's website. If you already have a myUHC.com account, log in to view your list of network providers and facilities. If you do not yet have an account, you may visit the comparison website created by UnitedHealthcare for university employees.

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If an employee retired, then returns to a benefit-eligible position, could the benefit change again?

We can't tell you absolutely that UM System retiree insurance will never change again. But at this time, we don’t anticipate additional changes. If an employee retires and comes back to a benefit-eligible position, the retiree would return to their original retiree insurance eligibility as of their original retirement date.

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I’m in Category B with 19 years of service on 1/1/18. Can I enroll in ret. insurance after 1/1/18?

If retiring 1/1/18 or later, you must work to at least age 60 and attain at least 20 years of service to be eligible for retiree insurance. Category B employees who work to age 60 and attain 20 years of service can enroll in UM System retiree insurance plans, any date after the employee reaches those two benchmarks.

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What services and tools does UnitedHealthcare provide?

UnitedHealthcare offers many tools to help make your medical insurance coverage work for you. The myUHC Cost Estimator can help you estimate your out-of-pocket health care costs prior to seeing a doctor. Additionally, the tool allows you to compare health cost estimates at different providers so you can be sure you’re making an informed decision about what is best for you.

The Health4Me app is another resource for accessing a wealth of healthcare information in seconds. The app lets you check your account balances and benefit amounts, stores your health plan ID card, collects and tracks your current Personal Health records, and helps you view, sort, and pay claims. Additionally, you can use the app much like you use the myUHC Cost Estimator when you compare costs of common procedures. You can even connect with healthcare professionals 24/7 as well as find in-network providers and hospitals nearby in case of emergency.

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Who is the university administrator for behavioral health?

Mental health coverage for active benefit-eligible employees and their dependents is offered through United Behavioral Healthcare’s (UBH) Live and Work Well program. Use the Live and Work Well program website to access benefits, manage claims, and get information on care and services. You can also search in-network clinicians to find your best provider.

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I’ve heard I can only retire at certain times of the year; is that true?

If you are in a 9-month appointment, you may retire on 3/1 or 9/1. All others can retire on any day of the year after meeting the eligibility requirements to be a retiree.

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Under the Affordable Care Act (PPACA), who’s required to track hours, and where do they track time?

Variable hour non‐exempt employees already track worked hours and will continue to do so.

Variable hour non‐teaching exempt employees (both staff and academics that are not fully benefit eligible) should record actual worked hours using a non‐pay time reporting code in the time reporting system. Partial hours should be rounded to the nearest half hour (i.e., 15 minutes or over round up to the next half hour and under 15 minutes round down to the previous half hour).

Variable hour teaching academic appointments quantify time worked using an equivalency of 3 1/3 hours worked for each credit hour taught. This methodology is used to determine their full-time equivalent (FTE). No action is required on the part of the individual. The FTE is entered by the department. This methodology should be applied regardless of the time period of which the class is taught (i.e., 8 weeks versus 16 weeks).

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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If spouses or qualified sponsored adult dependents work for UM, what if one retired while eligible for ret. insurance and the other didn’t?

If a spouse or qualified sponsored adult dependent lost eligibility for UM System retiree insurance, the retiree may add the spouse or qualified sponsored adult dependent immediately at the time coverage ends as a dependent for UM System retiree insurance benefits. Please keep in mind, the newly covered spouse or qualified sponsored adult dependent is eligible only for continued coverage under the same programs that individual was enrolled in as an eligible employee. Additionally, such a change must be made within 31 days after the change in status.

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Under PPACA, am I required to track hours for jobs worked outside of the university?

No, variable-hour employees do not have to track hours worked outside of the university.

The requirement is to track hours worked for the employer. Therefore, the university only has to track the hours that a variable hour employee works at the university. But if an employee works more than one job for the university, the UM System will track hours for all of those jobs.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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Does the Affordable Care Act (PPACA) teaching equivalency apply to all types of courses?

Yes. This equivalency (3 1/3 hours worked per credit hour taught) will be used for classroom credit courses, online courses, and courses taught by Graduate Teaching Assistants (GTAs).

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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What’s the penalty if the university doesn’t comply with Affordable Care Act (PPACA) requirements?

To comply with Patient Protection and Affordable Care Act (PPACA), the UM System must offer medical coverage to at least 95% of employees that average 30 hours per week or more. Not meeting this requirement will incur a penalty based on all benefit-eligible employees, which could be as much as $39,000,000 for UM.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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Are employees required to use vacation or leave when meeting with an EAP practitioner?

The Employee Assistance Program (EAP) is a benefit provided to all employees at no cost. Employees are not required to utilize any of their leave when meeting with a practitioner in the EAP. Visit the Employee Assistance Program webpage for more information.

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What HR policies have changed as a result of the PPACA?

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What Is Step Therapy through Express Scripts?

Step therapy is a program for people who take prescription drugs regularly to treat a medical condition, such as arthritis, asthma or high blood pressure. It allows you and your family to receive the affordable treatment you need and helps your organization continue with prescription-drug coverage.

In step therapy, drugs are grouped in categories, based on treatment and cost:

Front-line drugs — the first step — are generic and sometimes lower-cost brand drugs proven to be safe, effective and affordable. In most cases, you should try these drugs first because they usually provide the same health benefit as a more expensive drug, at a lower cost.
Back-up drugs — Step 2 and step 3 drugs — are brand-name drugs that generally are necessary for only a small number of patients. Back-up drugs are the most expensive option.

If you have more questions, you can go to StepTherapyFacts.com to watch informative videos or call the Express Scripts Pharmacy at the number on your ID card. (This FAQ answer provided by ExpressScripts.)

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Will the PPACA teaching equivalency adjust based on the number of students enrolled in the course?

No. The teaching equivalency for the Patient Protection and Affordable Care Act (PPACA), 3 1/3 hours worked per credit hour taught, will remain the same regardless of the number of enrolled students.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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Is vision insurance available for benefit-eligible faculty, staff, and retirees?

Yes. VSP Vision Care is the administrator for the University of Missouri System vision plan. Learn more about vision plans.

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What is COBRA?

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. COBRA requires that a medical plan offer covered employees and dependents the opportunity to continue coverage when it ends for certain specified reasons. Learn more about eligibility for continued coverage.

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Do cross-listed credit courses affect the Affordable Care Act (PPACA) teaching equivalency?

No. The teaching equivalency is 3 1/3 hours worked per credit hour taught. Since the course is a single course, the individual would receive 3 1/3 hours worked for each course credit hour.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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If I must go on a leave of absence, will I still retain my benefits?

Yes. During a leave of absence, you are eligible to continue to participate in the University of Missouri's staff benefit program (medical, dental, life, accidental death, and long-term disability).

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Under the Affordable Care Act, how should FTE be calculated when a course is shared by professors?

To calculate the full-time equivalency (FTE) for the Patient Protection and Affordable Care Act (PPACA), follow the agreed upon methodology of 3 1/3 worked hours per each credit hour taught for the course, and prorate the worked hours among the multiple professors based on the distribution of teaching effort.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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How do I maximize my Express Scripts prescription drug benefit?

In order to make the most of your prescription drug benefit through Express Scripts, it’s a good idea to use FDA-approved generic drugs whenever possible. If you are taking a brand-name drug that is not on the plan’s preferred drug list (called a “formulary”), ask your doctor if a preferred- brand drug or a generic would be right for you.

Similarly, fill prescriptions through a retail pharmacy in the Express Scripts network, or via home delivery from the Express Scripts PharmacySM. (Filling a greater than a 32 day supply of maintenance prescriptions at a University pharmacy is the same copay as home delivery.) Of course, many local pharmacies offer other low-cost generic programs, so it’s always a good idea to compare prices at all pharmacies to ensure the best price.

(This FAQ answer provided by Express Scripts.)

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Who decides what drugs are covered in the ExpressScripts Step Therapy program?

Step therapy is developed under the guidance and direction of independent, licensed doctors, pharmacists and other medical experts. Together with Express Scripts — the company chosen to manage your pharmacy benefit plan — they review the most current research on thousands of drugs tested and approved by the FDA for safety and effectiveness. Then they recommend appropriate prescription drugs for the step therapy program, and your organization’s pharmacy benefit plan chooses the drugs that will be covered. (This FAQ answer provided by ExpressScripts.)

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If I go on military leave, can I continue to receive my benefits?

Yes. If you are a fully benefit-eligible employee who has completed your probationary period, you can stay enrolled in some or all of the benefits in which you are already enrolled if you pay the amount that would normally have been deducted from you paycheck for you monthly premiums*.

*Note that the university's plans have a specific war exclusion. For details, see the appropriate plan’s Summary Plan Description (SPD) under the forms and guides section of the military leave: information on university benefits page.

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What is the teaching equivalency for courses taught on less than a 16-week standard semester?

The teaching equivalency for the Patient Protection and Affordable Care Act (PPACA), 3 1/3 hours worked per credit hour taught, remains the same: 1 credit hour taught equals 3 1/3 worked hours, regardless of the time period the class covers.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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What if I choose to suspend coverage while I’m on military leave?

If you choose to suspend coverage while on leave, you must resume your coverage within 31 days of your return to benefit-eligible university employment. If you suspend coverage, coverage is also suspended for all your dependents. Upon your return to work, the coverage for your dependents may be resumed along with your own coverage.

If you choose to suspend coverage while on military leave, coverage is also suspended for your dependents. However, you may enroll your family in a separate military health plan for dependents if you are called to active duty for more than 30 days. Immediately contact the appropriate Armed Forces personnel for information related to these plans, or visit Tricare for more information.

When you do return to benefit-eligible university employment, coverage for your dependents may be resumed along with your own coverage.

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Can dependents on active duty be covered under university benefits?

Dependents (including spouses) on active duty are not eligible for the university's medical or dental insurance coverage.

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What happens when I return to work from a leave of absence due to active duty?

When you return from a military leave of absence, you will be compensated at the rate of pay you would have received had you continued working during the period of leave. All time spent on a military leave of absence will be counted with previous university experience in calculating seniority and compensation.

If you become physically or mentally unqualified to perform the duties of your former position, you shall be offered employment in a position for which you are qualified.

Use the table below to find out how and when to return to work, based on your type and length of military leave:

Annual training session or emergency mobilization (1-30 days) Emergency mobilizations (31-180 days) Emergency mobilizations (181+ days)

Return to work the first regularly scheduled work day that would fall eight (8) hours after the person returns home.

An application for re-employment must be submitted no later than 14 days after completion of service.

 

An application for re-employment must be submitted no later than 90 days after completion of service; and the employee is qualified to perform the duties of the position.

Learn more about your options when taking a military leave of absence from a university job.

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How should employees with both teaching and non-teaching assignments record hours under PPACA?

For the Patient Protection and Affordable Care Act (PPACA), employees that have both teaching and non‐teaching responsibilities (e.g., a part‐time academic employee who teaches classes and also works in a research lab), use the full-time equivalency (FTE) to determine the hours worked. The FTE should include the credit given using the teaching equivalency(3 1/3 hours worked per credit hour taught), as well as a reasonable estimation of the hours spent doing non‐teaching assignments.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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How should hours for teaching clinical courses be tracked under the Affordable Care Act (PPACA)?

Hours worked in a clinical setting should be tracked in the same manner as a variable-hour, non‐teaching exempt employee by recording actual worked hours using a non‐pay time reporting code in the time reporting system.

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Where can I get information on tobacco cessation programs?

The Total Rewards website has information for each of the campuses regarding cessation programs with local resources.

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How should hours for teaching clinical courses be tracked under the Affordable Care Act (PPACA)?

For the Patient Protection and Affordable Care Act (PPACA), hours worked in a clinical setting should be tracked in the same manner as a variable-hour, non‐teaching exempt employee: by recording actual worked hours using a non‐pay time reporting code in the time reporting system.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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I’m in the step therapy program. Why couldn’t I fill my prescription at the pharmacy?

The first time you submit a prescription that isn’t for a front-line drug, your pharmacist should inform you that with step therapy you need to first try a front-line drug if you’d rather not pay full price for your prescription drug.

To receive a front-line drug:

  • Ask your pharmacist to call your doctor and request a new prescription.

OR

  • Contact your doctor to get a new prescription.

Only your doctor can change your current prescription to a first-step drug covered by your program.

 

If you have more questions, you can log in and go to www.StepTherapyFacts.com to watch informative videos or call the Express Scripts Pharmacy at the number on your ID card. (This FAQ answer provided by ExpressScripts.)

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What if I need more than the Employee Assistance Program’s short-term counseling sessions?

The Employee Assistance Program (EAP) is designed help university employees with personal or work-related problems by providing short-term counseling (up to 5 sessions).  EAP practitioners are trained in assessment. If it is determined that more than five sessions are needed, the practitioner will provide employees with a referral within the community. EAP practitioners attempt to ensure sure all referrals are covered by insurance, or if money is a concern, to help employees locate counseling services that are offered at a sliding fee or reduced rate. Visit the Employee Assistance Program webpage for more information.

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What’s the difference between generic and brand-name prescription drugs?

FDA-approved generic drugs must meet the same U.S. Food and Drug Administration (FDA) standards of quality and purity as brand-name drugs. FDA-approved generic versions have the same active ingredients as their brand-name counterparts are equal in strength and dosage. Sometimes drug manufacturers use different inactive ingredients in generic versions, which may affect its shape, color, size or taste.

(This FAQ answer provided by Express Scripts.)

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How can I find out if my doctor or other provider participates in Medicare?

To find out if your provider participates in Medicare, you can ask your provider or can visit the Medicare.gov website at www.medicare.gov/physiciancompare/search.html to search for your doctor. You can find additional information about Medicare, including the CMS “Medicare and You” brochure, on the Medicare.gov website at www.mymedicare.gov or by calling Medicare at 1-800-MEDICARE. TTY users should call 1-877-486-2048, 24 hours a day, seven days a week.

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Is there a specific set of job codes that fall into teaching academics?

There is some work being done on academic titles, so it may be possible in the future, but at this time there is no consistent way to distinguish a teaching academic from a non‐teaching academic by title alone. The same title has been used for both teaching and non‐teaching roles, as well as for both fully benefit-eligible and non‐benefit-eligible positions.

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What info is needed for me to be enrolled in one of the new UHC Group Medicare Advantage plans?

There is certain information you must provide and actions you must take before you can be enrolled in the new university-sponsored Medicare Advantage plans. Although sponsored by the university, because this coverage replaces your current Medicare Part A and Part B coverage, your enrollment must be approved by the Centers for Medicare and Medicaid (CMS) – the federal agency that is responsible for the administration of Medicare Advantage plans – before coverage becomes effective. CMS will approve enrollment into a Medicare Advantage plan if an individual: 

  • Is enrolled in Medicare Parts A and B,
  • Provides a Health Insurance Claim Number (HICN)/Medicare Claim Number,
  • Has a permanent U.S. street address (no P.O. Box) on file, and
  • Is not within the 30-month coordination period for end-stage renal disease.

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Why is “full-time equivalency (FTE)” not an accurate way to determine medical eligibility?

While full-time equivalency (FTE) is currently reported in job data, using FTE does not meet one of the safe harbor methods for tracking hours. The three safe harbor methods are (a) track actual hours, (b) days worked equivalency – credit eight hours worked for any day in which the employee works one hour, or (c) weeks worked equivalency – credit 40 hours worked for any week in which the employee works one hour. Using FTE for teaching academics is appropriate because it is based on an agreed upon documented methodology which is being applied consistently as allowed by the regulations.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

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Why do I need to provide my HICN/Medicare Claim Number and street address when I enroll?

This is a critical step in continuing your university retiree medical coverage. If you have already provided your HICN/Medicare Claim Number to the university and have a current permanent U.S. street address on file with the university, you will not need to provide this information again. For most individuals, the university has the information.

Under CMS rules, individuals must provide the following information before CMS will approve their enrollment in a Medicare Advantage plan such as the university-sponsored UHC Group Medicare Advantage plans:

  • Health Insurance Claim Number (HICN)/Medicare Claim Number
  • Street Address (other than a P.O. Box)

To facilitate the collection of this information, the university will be contacting those Medicareeligible retirees and their covered Medicare-eligible dependents who do not have HICNs/Medicare Claim Numbers and/or street addresses on file with instructions on how to provide that information.

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How can I check if the university has my Health Insurance Claim Number (HICN)/Medicare Claim Number?

The university will send out a letter requesting this information from those retirees or their eligible dependents who do not already have HICNs on file with the university.

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What if I don’t enroll in Medicare Parts A and B?

The Centers for Medicare and Medicaid Services (CMS) require you to be enrolled in Medicare Parts A and B, and that you continue to pay your Part B premium (as you do today if you are already enrolled in Medicare), to participate in a Medicare Advantage plan such as the new university-sponsored UHC Group Medicare Advantage plans. Therefore, to remain eligible for your university retiree medical coverage, you must remain enrolled in Medicare Parts A and B. If you are a pre-1990 university retiree, or retired from the Federal Civil Service or the Missouri State Retirement System and have not previously enrolled in Medicare or are not eligible to enroll in Medicare, please contact that the university to discuss your plan options.

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