Medical Plans

State Non-Medicare Retirees

MCHCP offers three health plan options that include medical coverage administered by Anthem, and prescription drug coverage administered by Express Scripts. Each option offers the same nationwide networks. You can access non-network providers, too. Network preventive services are paid at 100%.

The HSA Plan is a qualified high-deductible plan that can help you save money by giving you access to a health savings account (HSA). On the HSA Plan, you will pay all medical and prescription drug expenses until your individual deductible is met — then you will usually pay coinsurance. MCHCP offers two PPO plans – the PPO 1250 Plan and PPO 750 Plan. The plan names come from the individual deductible amounts associated with them — $1,250 for the PPO 1250 Plan and $750 for the PPO 750 Plan. Under our PPO plans, most services are subject to deductible and coinsurance. There are also some services covered at no cost to MCHCP members.

Medical Plans Overview

	Health Savings Account (HSA) Plan		PPO 1250 Plan		PPO 750 Plan
Benefit Description	Network	Non-Network	Network	Non-Network	Network	Non-Network
Deductible (must meet deductible before coinsurance)	Health Savings Account (HSA) Plan Network $1,800/individual $3,600/family	Non-Network $3,300/individual $6,600/family	PPO 1250 Plan Network $1,250/individual $2,500/family	Non-Network $2,500/individual $5,000/family	PPO 750 Plan Network $750/individual $1,500/family	Non-Network $1,500/individual $3,000/family
Medical Out-of-Pocket Maximum	Health Savings Account (HSA) Plan Network $5,400/individual $10,800/family *	Non-Network $9,900/individual $19,800/family	PPO 1250 Plan Network $3,750/individual $7,500/family	Non-Network $7,500/individual $15,000/family	PPO 750 Plan Network $2,250/individual $4,500/family	Non-Network $4,500/individual $9,000/family
Preventive Services	Health Savings Account (HSA) Plan Network MCHCP pays 100%	Non-Network 40% coinsurance	PPO 1250 Plan Network MCHCP pays 100%	Non-Network 40% coinsurance	PPO 750 Plan Network MCHCP pays 100%	Non-Network 40% coinsurance
Office Visit	Health Savings Account (HSA) Plan Network 20% coinsurance	Non-Network 40% coinsurance	PPO 1250 Plan Network Primary Care or Mental Health: $25 copayment Specialist: $40 copayment Chiropractor: $20 copayment or 50% of total cost of service, whichever is less	Non-Network 40% coinsurance	PPO 750 Plan Network 20% coinsurance	Non-Network 40% coinsurance
Virtual Care through Sydney Health, Hinge Health, and Lark’s Virtual Diabetes Prevention Program	Health Savings Account (HSA) Plan Network MCHCP pays 100%	Non-Network N/A	PPO 1250 Plan Network MCHCP pays 100%	Non-Network N/A	PPO 750 Plan Network MCHCP pays 100%	Non-Network N/A
Urgent Care	Health Savings Account (HSA) Plan Network 20% coinsurance	Non-Network Paid as Network Benefit	PPO 1250 Plan Network $50 copayment	Non-Network Paid as Network Benefit	PPO 750 Plan Network 20% coinsurance	Non-Network Paid as Network Benefit
Emergency Room	Health Savings Account (HSA) Plan Network 20% coinsurance	Non-Network Paid as Network Benefit	PPO 1250 Plan Network $250 copayment plus 20% coinsurance	Non-Network Paid as Network Benefit	PPO 750 Plan Network $250 copayment plus 20% coinsurance	Non-Network Paid as Network Benefit
Hospital (Inpatient)	Health Savings Account (HSA) Plan Network 20% coinsurance	Non-Network 40% coinsurance	PPO 1250 Plan Network $200 copayment plus 20% coinsurance	Non-Network $200 copayment plus 40% coinsurance	PPO 750 Plan Network $200 copayment plus 20% coinsurance	Non-Network $200 copayment plus 40% coinsurance
Lab and X-ray	Health Savings Account (HSA) Plan Network 20% coinsurance	Non-Network 40% coinsurance	PPO 1250 Plan Network 20% coinsurance	Non-Network 40% coinsurance	PPO 750 Plan Network 20% coinsurance	Non-Network 40% coinsurance
Surgery	Health Savings Account (HSA) Plan Network 20% coinsurance	Non-Network 40% coinsurance	PPO 1250 Plan Network 20% coinsurance	Non-Network 40% coinsurance	PPO 750 Plan Network 20% coinsurance	Non-Network 40% coinsurance

Missouri state law, Section 191.724, RSMo, allows a person the right to decline or refuse coverage for contraception if these items or procedures are contrary to an employee’s religious beliefs or moral convictions.

Medical Plan Videos

MCHCP has created videos to help explain insurance terms and descriptions, and to educate members about our medical plan benefit options.

MCHCP is constantly evaluating the best way to communicate with its members. MCHCP currently utilizes Google’s YouTube service to host informational videos. We understand that not all state agencies allow content from YouTube through their approved content web filters. Please see your respective IT department for help in gaining access to our video content or review them from a device connected by a non-state internet service provider.

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