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Program
Topic
Document Type
 
Name/Description File type
Retiree Benefits Change Form and Retiree Beneficiary Designation Information (combo pack of forms)

Combo pack of forms, including: (1) Retiree benefits enrollment/change form to be used to change insurance elections. (2) Beneficiary designations form for basic life, supplemental life, and accidental death and dismemberment plans. Cannot be used during retirees’ Annual Enrollment period.

Note: The retiree beneficiary designation form is available on pg. 3.

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Proof of relationship requirement

Proof of relationship requirements to confirm the individual or individuals to be covered are eligible under the specific definitions of the plans.

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Medical claim form for retirees (Coventry) for 2016

Medical claim form for retirees under university medical insurance plans for calendar year 2016. Coventry is the administrator.

PDF
Prescription drug mail-in form

Express Scripts prescription drug mail-in order form.

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Release of health information form (HIPAA)

Form for authorization of release of personal health information under HIPAA.

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Retiree Health PPO Plan Summary Plan Description (SPD) for calendar year 2017

Summary plan description for the Retiree Health PPO Plan for 2017.

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Retiree Healthy Savings Plan Summary Plan Description (SPD) for calendar year 2017

Summary plan description for the Retiree Healthy Savings Plan for 2017.

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What You Need to Know About Your Medicare Advantage Plan: 2017 Plan Guide

The enrollment guide for retirees and dependents enrolling in the university-sponsored Medicare Advantage Base Plan or Medicare Advantage Enhanced Plan. This document was produced and distributed by UnitedHealthcare, who is delivering the university-sponsored Medicare Advantage group plans. This document is for the 2017 calendar year, and provides both Summary Plan Description (SPD) and Summary of Benefits and Coverage (SBC) information for the two Medicare Advantage plans.

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2017 preferred drug formulary - Medicare Advantage Base and Enhanced plans

Drug formulary from Express Scripts Medicare, current as of August 22, 2016. This list of covered drugs is for these university group Medicare insurance plans: Medicare Advantage Base Plan (plan #13759) and Medicare Advantage Enhanced Plan (plan #13760).

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2017 Specialty drug list

2017 calendar year Specialty Drug List from Accredo, an Express Scripts Company, regarding maintenance medications for active employees with the Custom Network Plan, Health Savings Plan, or PPO Plan. This list also covers retirees with the Healthy Savings Plan or Retiree Health PPO Plan, with Rx.

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Creditable coverage notice for university-sponsored Medicare Advantage Plans with Rx coverage

The University of Missouri System has determined that the prescription drug coverage offered in conjunction with the University-sponsored Medicare Advantage (Base or Enhanced) Plans are, on average for all plan participants, expected to pay out as much as the standard Medicare Part D prescription drug coverage will pay and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

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Medical and Dental Benefits Plans notice of privacy practices

This notice of privacy practices describes how health information about employees may be used and disclosed and how individuals can access to this information.

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Non-creditable coverage notice for university-sponsored Medicare Advantage Plans with no Rx

The University of Missouri System has determined that the prescription drug coverage offered by the University-sponsored Medicare Advantage (Base or Enhanced) Plans–no Rx is, on average, NOT expected to pay out as much as the standard Medicare Part D prescription drug coverage will pay and is considered Non-Creditable Coverage. This is important because, most likely, you will get more help with your drug costs if you join a Medicare drug plan. This also is important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become eligible.

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M4A Medicare presentation

Missouri Association of Area Agencies on Aging provides this presentation on Medicare.

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2017 Benefit Plans for retirees/dependent - Medicare Advantage Base and Enhanced plans

Watch this online seminar to learn about the university-sponsored, group Medicare Advantage Base Plan and Medicare Advantage Enhanced Plan, available to Medicare-eligible retirees and dependents for the 2017 calendar year. This seminar was produced and distributed by UnitedHealthcare, who is delivering the university-sponsored Medicare Advantage group plans.

Video
Healthy Savings Plan summary of benefits and coverage (SBC) for calendar year 2017

Summary of benefits and coverage (SBC) document for active employees' Healthy Savings Plan for 2017.

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Medicare Advantage Base & Enhanced plans summary of benefits and coverage (SBC) for 2017

The 2017 summary of benefits and coverage (SBC) for the university-sponsored Medicare Advantage Base Plan and Medicare Advantage Enhanced Plan are part of a broader document, titled What You Need to Know About Your Medicare Advantage Plan: 2017 Plan Guide. SBC-related information for the Medicare Advantage Base Plan (Plan #13759) is found on pp. 6-7 and 17-28. SBC-related information for the Medicare Advantage Enhanced Plan (Plan #13760) is found on pp. 8-9 and 29-40.

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PPO Plan summary of benefits and coverage (SBC) for calendar year 2017

Summary of benefits and coverage document (SBC) for the PPO Plan for MU, MUHC, UMSL and UM System central administration for 2017.

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Retiree Health PPO Plan summary of benefits and coverage (SBC) for calendar year 2018

Summary of benefits and coverage (SBC) document for the Retiree Health PPO Plan for 2018.

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Retiree Healthy Savings Plan summary of benefits and coverage (SBC) for calendar year 2017

Summary of benefits and coverage (SBC) document, for retirees, for the Healthy Savings Plan for 2017. Active employees should reference the "Healthy Savings Plan SBC."

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