The Preferred Provider Organization (PPO) Plan is available to all active benefit-eligible faculty and staff who do not live or work in one of the counties that makes them eligible for the similar PPO Plan with Tiered Feature. Check out the eligibility section of this webpage for additional details. Retirees are not eligible for this plan; instead, retirees have access to the Retiree Health PPO Plan.
Jump to: 2025 PPO Plan | 2024 PPO Plan
2025 PPO Plan
911±¬ÁÏÍø the Plan
The PPO Plan is available if you do not live or work in one of the counties that makes you eligible for the PPO Plan with Tiered Feature (also called Tiered PPO Plan). It is a traditionally structured medical insurance plan with a broad network of providers. You pay deductibles for medical expenses and prescription drugs even if you use in-network services. This means, for most covered expenses, you¡¯ll pay for expenses until you reach the annual deductible.
Click on a header to expand the selection and uncover additional information.
? Plan Features
- There are separate deductibles for in-network services and retail prescription drugs.
- Once you meet your annual out-of-pocket limit, the plan pays 100% of expenses (including coinsurance and copayments) for the remainder of the calendar year.
- You can enroll in two types of Flexible Spending Accounts (FSA): Health Care FSA and Dependent Care FSA. These accounts help you pay for medical or child care using pre- tax dollars. Eligible expenses differ between the types.
- For those in the Columbia area, 90-day fills/refills are available at Mizzou pharmacies at the same cost as mail-order. Participants may fill specialty medications through a or Accredo.
? Eligibility
All active benefit-eligible faculty and staff have access to a type of PPO Plan, but may have access to the additional tiered feature depending on where they live and/or work. Access to the tiered feature is determined by county. Eligible counties are in the Kansas City and Rolla geographic areas; see the PPO Plan with Tiered Feature (also called Tiered PPO Plan) webpage for additional information. If you do not live or work in one of the counties eligible for the Tiered PPO Plan, then you will have access to the base PPO Plan.
Eligibility for both PPO Plan versions
Most faculty and staff have one version of the PPO Plan available to them (either with or without Tiered Feature).
However, a small group have home and business addresses such that both the PPO Plan and the Tiered PPO Plan options will show up in myHR as available when completing enrollment. If this is the case, take extra caution to ensure that you select the version that is best for you. Both versions of the PPO Plan utilize the same broad network of providers.
Coverage for dependents
Dependents may include:
- Spouse or Sponsored Adult Dependent of an employee
- A child of an employee who is younger than 26 years of age
- A child of an employee over the age of 26 who is mentally or physically incapable of self-sustaining employment and meets other plan requirements
- Child for whom health care coverage is required through a Qualified Medical Child Support Order or other court/administrative order.
You should ensure you understand the details of your status by accessing the Summary Plan Description (SPD) for the insurance plan and reading the full definition.
Costs
Click on a header to expand the selection and uncover additional information.
? Premiums
Monthly employee premium cost* for active employees:
- Self only: $196
- Self and spouse: $479
- Self and child(ren): $455
- Self, spouse and child(ren): $769
*Premiums for faculty on a nine-month contract paid over nine months are different. For more information, visit the Premiums for 9-month faculty paid over 9 months webpage.
? Covered Services
What you pay for covered services varies based on whether the provider is in-network or out-of-network:
In-Network Services
|
Out-of-Network Services**
|
**Refer to the Summary Plan Description (SPD) for additional details on allowable and eligible expenses when using an out-of- network provider.
? Prescription Drugs
- Prescription drug: Retail Non-Maintenance:
- In-network: Greater of (after Rx deductible):
- Formulary generic: $10 copay or 20% coinsurance
- Formulary brand: $30 copay or 25% coinsurance
- Non-formulary brand: $50 copay or 50% coinsurance
- Out-of-network**: $30 copay or 50% network costs or more after deductible**
- In-network: Greater of (after Rx deductible):
- Prescription drug: Retail Maintenance:
- In-network: Greater of (after Rx deductible):
- Formulary generic: $15 copay or 25% coinsurance
- Formulary brand: $40 copay or 30% coinsurance
- Non-formulary brand: $60 copay or 55% coinsurance
- Out-of-network**: $30 copay or 50% network costs or more after deductible**
- In-network: Greater of (after Rx deductible):
- Prescription drug: Mail:
- In-network: Greater of:
- Formulary generic: $20 or 20% coinsurance
- Formulary brand: $60 or 25% coinsurance
- Non-formulary brand: $100 or 50% coinsurance
- Out-of-network**: $30 copay or 50% network costs or more after deductible**
- In-network: Greater of:
* 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.
? Deductible
The PPO Plan has two annual deductibles: one for medical and a second for prescription drug costs.
- Medical deductible:
- In-network: $800/self*; $2,400/family
- Out-of-network: $1,600/self*; $4,800/family*
- Rx deductible:
- Retail: $75/person
- Mail-order: $0/person
* Considerations for ¡°self¡± and ¡°family¡± are different for the Custom Network Plan and PPO Plan than the Healthy Savings Plan. Visit the glossary for details.
? Out-of-Pocket Limit
The PPO Plan has two annual out-of-pocket limits: one for medical and a second for prescription drug costs.
- Medical out-of-pocket limit:
- In-network: $3,750/self*; $7,500/family*
- Out-of-network**: $11,250 or more/self; $22,500 or more/family*
- Rx out-of-pocket limit:
- $5,450/self*; $10,900/family*
* Considerations for ¡°self¡± and ¡°family¡± are different for the Custom Network Plan and PPO Plan than the Healthy Savings Plan. Visit the glossary for details.
**Please refer to the Summary Plan Description (SPD) for additional details on allowable/eligible expenses when using an out-of-network provider.
For a printable version, download the (386KB, PDF), which features a comparison chart and premium rates for the available insurance plans.
Making the Most of Your Plan
Click on a header to expand the selection and uncover additional information.
? Consider a Flexible Spending Account
If you enroll in the PPO plan, you may also want to consider enrolling in a Health Care Flexible Spending Account (FSA), an account that allows you to set aside pre-tax dollars to pay for out-of-pocket medical expenses. Visit the Understanding your flexible spending account webpage to learn more.
? Rx Cost Estimator
To estimate prescription costs, visit (available Oct. 2024; 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.
? Network Providers
You may choose to visit either in-network or out-of-network physicians 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
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 and Special Health Topics
Preventive Care
Many health plans include preventive care services, such as various screenings, vaccinations and well-woman visits, at no out-of pocket cost. Read about women's preventive healthcare or learn more about UHC's (exit UM System site).
Special Health Topics
Consult the following webpages for additional information on special health topics:
? Discounts
Visit the health and wellness tools and discounts webpage to maximize your convenience and savings.
2024 PPO Plan
911±¬ÁÏÍø the Plan
The PPO Plan is available if you do not live or work in one of the counties that makes you eligible for the PPO Plan with Tiered Feature (also called Tiered PPO Plan). It is a traditionally structured medical insurance plan with a broad network of providers. You pay deductibles for medical expenses and prescription drugs even if you use in-network services. This means, for most covered expenses, you¡¯ll pay for expenses until you reach the annual deductible.
Click on a header to expand the selection and uncover additional information.
? Plan Features
- There are separate deductibles for in-network services and retail prescription drugs.
- Once you meet your annual out-of-pocket limit, the plan pays 100% of expenses (including coinsurance and copayments) for the remainder of the calendar year.
- You can enroll in two types of Flexible Spending Accounts (FSA): Health Care FSA and Dependent Care FSA. These accounts help you pay for medical or child care using pre- tax dollars. Eligible expenses differ between the types.
- For those in the Columbia area, 90-day fills/refills are available at Mizzou pharmacies at the same cost as mail-order. Participants may fill specialty medications through a or Accredo.
? Eligibility
All active benefit-eligible faculty and staff have access to a type of PPO Plan, but may have access to the additional tiered feature depending on where they live and/or work. Access to the tiered feature is determined by county. Eligible counties are in the Kansas City and Rolla geographic areas; see the PPO Plan with Tiered Feature (also called Tiered PPO Plan) webpage for additional information. If you do not live or work in one of the counties eligible for the Tiered PPO Plan, then you will have access to the base PPO Plan.
Eligibility for both PPO Plan versions
Most faculty and staff have one version of the PPO Plan available to them (either with or without Tiered Feature).
However, a small group have home and business addresses such that both the PPO Plan and the Tiered PPO Plan options will show up in myHR as available when completing enrollment. If this is the case, take extra caution to ensure that you select the version that is best for you. Both versions of the PPO Plan utilize the same broad network of providers.
Coverage for dependents
Dependents may include:
- Spouse or Sponsored Adult Dependent of an employee
- A child of an employee who is younger than 26 years of age
- A child of an employee over the age of 26 who is mentally or physically incapable of self-sustaining employment and meets other plan requirements
- Child for whom health care coverage is required through a Qualified Medical Child Support Order or other court/administrative order.
You should ensure you understand the details of your status by accessing the Summary Plan Description (SPD) for the insurance plan and reading the full definition.
Costs
Click on a header to expand the selection and uncover additional information.
? Premiums
Monthly employee premium cost* for active employees:
- Self only: $187
- Self and spouse: $457
- Self and child(ren): $435
- Self, spouse and child(ren): $735
*Premiums for faculty on a nine-month contract paid over nine months are different. For more information, visit the Premiums for 9-month faculty paid over 9 months webpage.
? Covered Services
What you pay for covered services varies based on whether the provider is in-network or out-of-network:
In-Network Services
|
Out-of-Network Services**
|
**Refer to the Summary Plan Description (SPD) for additional details on allowable and eligible expenses when using an out-of- network provider.
? Prescription Drugs
- Prescription drug: Retail:
- In-network: Greater of (after Rx deductible):
- Formulary generic: $10 copay or 20% coinsurance
- Formulary brand: $30 copay or 25% coinsurance
- Non-formulary brand: $50 copay or 50% coinsurance
- Out-of-network**: $30 copay or 50% network costs or more after deductible**
- In-network: Greater of (after Rx deductible):
- Prescription drug: Mail:
- In-network: Greater of:
- Formulary generic: $20 or 20% coinsurance
- Formulary brand: $60 or 25% coinsurance
- Non-formulary brand: $100 or 50% coinsurance
- Out-of-network**: $30 copay or 50% network costs or more after deductible**
- In-network: Greater of:
* 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.
? Deductible
The PPO Plan has two annual deductibles: one for medical and a second for prescription drug costs.
- Medical deductible:
- In-network: $800/self*; $2,400/family
- Out-of-network: $1,600/self*; $4,800/family*
- Rx deductible:
- Retail: $75/person
- Mail-order: $0/person
* Considerations for ¡°self¡± and ¡°family¡± are different for the Custom Network Plan and PPO Plan than the Healthy Savings Plan. Visit the glossary for details.
? Out-of-Pocket Limit
The PPO Plan has two annual out-of-pocket limits: one for medical and a second for prescription drug costs.
- Medical out-of-pocket limit:
- In-network: $3,750/self*; $7,500/family*
- Out-of-network**: $11,250 or more/self; $22,500 or more/family*
- Rx out-of-pocket limit:
- $5,200/self*; $10,400/family*
* Considerations for ¡°self¡± and ¡°family¡± are different for the Custom Network Plan and PPO Plan than the Healthy Savings Plan. Visit the glossary for details.
**Please refer to the Summary Plan Description (SPD) for additional details on allowable/eligible expenses when using an out-of-network provider.
For a printable version, download the (386KB, PDF), which features a comparison chart and premium rates for the available insurance plans.
Making the Most of Your Plan
Click on a header to expand the selection and uncover additional information.
? Consider a Flexible Spending Account
If you enroll in the PPO plan, you may also want to consider enrolling in a Health Care Flexible Spending Account (FSA), an account that allows you to set aside pre-tax dollars to pay for out-of-pocket medical expenses. Visit the Understanding your flexible spending account webpage to learn more.
? Rx Cost Estimator
To estimate prescription costs, visit (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.
? Network Providers
You may choose to visit either in-network or out-of-network physicians 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
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 and Special Health Topics
Preventive Care
Many health plans include preventive care services, such as various screenings, vaccinations and well-woman visits, at no out-of pocket cost. Read about women's preventive healthcare or learn more about UHC's (exit UM System site).
Special Health Topics
Consult the following webpages for additional information on special health topics:
? Discounts
Visit the health and wellness tools and discounts webpage to maximize your convenience and savings.
* 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 2024-09-24
