he Retiree Health PPO Plan offers access to a broad network of providers nationwide. 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.

Plan Availability

The Retiree Health PPO Plan is available to retirees and their dependents who are not yet eligible for Medicare. 

For more information on eligibility for benefits coverage, including covering dependents, see Benefit Eligibility & Program Structure.

How Much You Pay For Coverage

Costs

Monthly Cost

Premiums

Your share of premiums is determined by a formula that considers your age, years of service at retirement and the program under which your benefits are payable. 

See Retiree Insurance for details on eligibility, subsidy and to estimate premiums. 

For plan information, refer to the Summary Plan Description (SPD).

Amount Owed Before Insurance Pays

Deductible

The Retiree Health PPO Plan has two annual deductibles: one for medical and a second for prescription drug costs.

  • Medical deductible: 
    • In-network: $1,700/self; $5,100/family
    • Out-of-network:  $4,400/self; $13,200/family
  • Rx deductible: $75/person

Max You Pay Annually

Out-of-Pocket Limit

The Retiree Health 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:  $5,100/self; $10,200/family
    • Out-of-network:  $8,800 or more/self; $17,600 or more/family
  • Rx out-of-pocket limit: $3,800/self; $7,600/family

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

ServiceIn-Network CostOut-of-Network Cost**
Preventive Care$040% or more after deductible
Primary Care30% coinsurance after deductible40% or more after deductible
Specialist Care30% coinsurance after deductible40% or more after deductible
Urgent Care30% coinsurance after deductible40% or more after deductible
Lab & X-Ray30% coinsurance after deductible40% or more after deductible
Outpatient Care30% coinsurance after deductible40% or more after deductible
Inpatient Care 
(includes maternity delivery)		$325 copay per admissions, then 30% coinsurance after deductible40% or more after deductible
Durable Medical Equipment30% coinsurance after deductible40% or more after deductible
Emergency Room30% coinsurance after deductible30% coinsurance after deductible
Ambulance30% coinsurance after deductible30% coinsurance 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 TypeNetworkFormulary GenericFormulary BrandNon-Formulary Brand
Retail, non-maintenanceIn-Network (greater of)$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, MaintenanceIn-Network
(greater of)		$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
MailIn-Network
(greater of)		$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
Close up of doctor in a lab coat holding a clip board and pen, stethoscope around their neck.

Making the Most of Your Coverage

Whether you¡¯re learning about retiree insurance or already enrolled in a medical plan, you can use these resources to take the next steps. Find out more about enrolling or making plan changes, learn how to make the most of your insurance day-to-day, and explore how coverage applies to specific health needs.

Retiree Insurance Enrollment & Changes
Using Your Coverage
Preventive & Special Health Topics

Plan Documents & Resources

Notice of Nondiscrimination

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