Overview of 2013 Medical Plans

MCHCP medical benefits are not available to employees of Missouri Department of Transportation, Missouri Department of Conservation or Missouri Highway Patrol.

Additional Plans

Comparison of Benefits

  PPO 300 Plan

PPO 600 Plan

High Deductible Health Plan (HDHP) with Health Savings Account (HSA)**
Through UMR (all regions) or Coventry Health Care* (Southwest and South Central regions only) Through UMR (all regions)
  Network Non-Network Network Non-Network Network Non-Network
Plan Description You pay the deductible and coinsurance amounts until
you reach the
out-of-pocket maximum.
You pay higher deductible and coinsurance amounts until
you reach the
out-of-pocket maximum.
You pay the deductible and coinsurance amounts until
you reach the
out-of-pocket maximum.
You pay higher deductible and coinsurance amounts until
you reach the
out-of-pocket maximum.
You pay the deductible and coinsurance amounts until
you reach the
out-of-pocket maximum.
You pay higher deductible and coinsurance
amounts until
you reach the
out-of-pocket maximum.
Your HSA can be used to help pay medical and prescription expenses.
Deductible
Individual
Family

$300
$600

$600
$1,200

$600
$1,200

$1,200
$2,400

$1,250
$2,500

$2,500
$5,000
Out-of-Pocket Maximum
Individual
Family



$1,200
$2,400



$2,400
$4,800



$1,500
$3,000



$3,000
$6,000



$2,500
$5,000



$5,000
$10,000
Preventive Services 100% coverage 30% coinsurance after deductible 100% coverage 30% coinsurance after deductible 100% coverage 40% coinsurance after deductible
Office Visit Primary Care:
$25 copayment***
Specialist:
$40 copayment***
Chiropractor:
$20 copayment
With Medicare:
10% coinsurance after deductible
30% coinsurance after deductible 10% coinsurance after deductible 30% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Urgent Care $50 copayment***
With Medicare:
10% coinsurance after deductible
$50 copayment***
With Medicare: 10% coinsurance after network deductible
10% coinsurance after deductible 10% coinsurance after network deductible 20% coinsurance after deductible 20% coinsurance after network deductible
Emergency Room $200 copayment****
With Medicare:
10% coinsurance
$200 copayment****
With Medicare: 10% coinsurance after network deductible
10% coinsurance after deductible 10% coinsurance after network deductible 20% coinsurance after deductible 20% coinsurance after network deductible
Hospital (Inpatient) 10% coinsurance after deductible 30% coinsurance after deductible 10% coinsurance after deductible 30% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Lab and
X-ray
10% coinsurance after deductible 30% coinsurance after deductible 10% coinsurance after deductible 30% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Surgery 10% coinsurance after deductible 30% coinsurance after deductible 10% coinsurance after deductible 30% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible
Prescription Drugs 100% coverage for formulary birth control and tobacco cessation prescriptions.
At network pharmacies, PPO Plan members pay a copayment. HDHP members pay the full price of prescriptions until the deductible is met, then pay coinsurance.
At non-network pharmacies, you pay the full price of the prescription and file a claim. You are reimbursed the network discounted amount, less the applicable copayment or coinsurance.
Find detailed coverage information in the Prescription Drug Benefit Chart.

* Southwest Region Counties: Barry, Barton, Cedar, Christian, Dade, Dallas, Greene, Hickory, Jasper, Laclede, Lawrence, McDonald, Newton, Polk, St. Clair, Stone, Taney, Vernon and Webster South Central Region Counties: Douglas, Howell, Oregon, Ozark, Shannon, Texas and Wright

**If two or more family members are covered by an HDHP, the family deductible must be met before the plan begins paying medical or prescription claims for any member of the family.

*** The PPO 300 Plan copayments differ from the copayments under the old Copay or HMO plans. The primary care, specialist, chiropractor and urgent care copayments cover the office visit only. You will be responsible for the cost of any lab, X-ray or other services associated with the visit, which apply to your deductible and out-of-pocket maximum.

**** The emergency room copayment covers all services associated with the visit. If you visit the ER and are admitted to the hospital, the copayment will be waived, and all services will apply to the deductible and out-of-pocket maximum.

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