The PPO Plan offers access to a broad network of providers nationwide. This traditionally-structured plan has the highest monthly premium among medical plan options and includes an annual deductible, along with copayments and coinsurance for medical services and prescription drugs, until the annual out-of-pocket maximum is reached.
Plan Availability
Plan Availability
The PPO Plan is available regardless of location.
For more information on eligibility for benefits coverage, including covering dependents, see Benefit Eligibility & Program Structure.
Costs
Costs
Monthly Cost
Premiums
Monthly employee premium cost* for active employees:
- Self only: $216
- Self and spouse: $526
- Self and child(ren): $500
- Self, spouse and child(ren): $847
*Premiums for faculty on a nine-month contract paid over nine months are different. For more information, visit Premiums for 9-month faculty paid over 9 months.
Amount Owed Before Insurance Pays
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
Individual deductibles must be satisfied per person for all individuals covered until the family deductible is met.
Max You Pay Annually
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:
- $6,850/self; $13,700/family
Once the annual out-of-pocket limit is met, the plan pays 100% of covered services for the rest of the year.
Covered Services
You may choose to visit either in-network or out-of-network physicians and other providers. Your costs will be discounted, however, when you select in-network providers. You pay the total of the discounted price until the deductible is met.
See Plan Contacts & Provider Directories
Service | In-Network Cost | Out-of-Network Cost** |
|---|---|---|
Preventive Care | $0 | 40% or more after deductible |
Primary Care | $25 copay/visit | 40% or more after deductible |
Specialist Care | $40 copay/visit | 40% or more after deductible |
Urgent Care | $100 copay/visit | $100 copay/visit or more |
Lab & X-Ray | 20% after deductible | 40% or more after deductible |
Outpatient Care | 20% after deductible | 40% or more after deductible |
Inpatient Care | 20% after deductible | 40% or more after deductible |
Durable Medical Equipment | 20% after deductible | 40% or more after deductible |
Emergency Room | $250 copay/visit after deductible | $250 copay/visit or more after deductible |
Ambulance | 20% after deductible | 20% or more after deductible |
**Refer to the Summary Plan Description (SPD) for additional details on allowable and eligible expenses when using an out-of-network provider.
Prescription Drugs
The cost of prescription drugs is discounted in-network based on the University’s negotiated rate. You pay the total of the discounted price until the deductible is met. For out-of-network claims, members pay the difference between the non-participating and participating pharmacy charge.
Specialty medications are managed and processed through ArchimedesRx. For retail drugs, 90-day fills or refill at Mizzou pharmacies are the same cost as mail-order.
Prescription Type | Network | Formulary Generic | Formulary Brand | Non-Formulary Brand |
|---|---|---|---|---|
Retail, non-maintenance | In-Network | $10 copay or 20% coinsurance | $30 copay or 25% coinsurance | $50 copay or 50% coinsurance |
Out-of-Network | $30 copay or 50% network costs or more after deductible | $30 copay or 50% network costs or more after deductible | $30 copay or 50% network costs or more after deductible | |
Retail, Maintenance | In-Network | $15 copay or 25% coinsurance | $40 copay or 30% coinsurance | $60 copay or 55% coinsurance |
Out-of-Network | $30 copay or 50% network costs or more after deductible | $30 copay or 50% network costs or more after deductible | $30 copay or 50% network costs or more after deductible | |
In-Network | $20 copay or 20% coinsurance | $60 copay or 25% coinsurance | $100 copay or 50% coinsurance | |
Out-of-Network | $30 copay or 50% network costs or more after deductible | $30 copay or 50% network costs or more after deductible | $30 copay or 50% network costs or more after deductible |
Consider Account Options
Consider Account Options
Pay for Medical, Dental & Vision Costs
Health Care FSA
Set aside pre-tax dollars to help cover medical, dental and vision expenses for you and your dependents, even if those dependents don’t have university insurance. Reduce taxable income up to IRS limits while making routine healthcare costs easier to manage.
Cover Child & Adult Dependent Care
Dependent Care FSA
Pay for eligible childcare or adult dependent care during the workday with pre-tax dollars, helping you balance work and family. IRS limits apply, and this account can save you money while ensuring your dependents get the care they need.
Making the Most of Your Coverage
Making the Most of Your Coverage
Whether you’re learning about University insurance or already enrolled in a medical plan, you can use these resources to find out more about the breadth of your coverage.
Learn about enrolling or making plan changes and how to make the most of your insurance day-to-day, plus explore how coverage applies to specific health needs to get the support you need when you need it.
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