Custom Network Plan

• A custom network offers a smaller pool of in-network providers in exchange for decreased premium or service costs. See eligibility below for which version(s) of the plan are available to you.
  • The narrow network of providers for Columbia and St. Louis are different.
  • You only have in-network access to providers associated with the version of the plan in which you enroll.
• 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 eligible coinsurance and copayment expenses for the rest of the calendar year.
• You may 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.

If you are a benefit-eligible faculty or staff member with a home address or official business unit in an eligible region around Columbia or St. Louis, the Custom Network Plan is available to you. Counties are different for the Columbia and St. Louis plans, as follows:

• Columbia: There are eligible counties in mid-Missouri.
  • Missouri counties: Audrain, Boone, Callaway, Cole, Cooper, Howard, Moniteau, Osage and Randolph.
  • See the Columbia CNP coverage map (PDF, 109KB).
• St. Louis: There are eligible counties in both Missouri and Illinois.
  • Missouri counties: Franklin, Gasconade, Jefferson, Lincoln, Montgomery, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, and Washington.
  • Illinois counties: Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Pike, Randolph and St. Clair.
  • See the St. Louis CNP coverage map (PDF, 140KB)

You may be eligible for both the Custom Network Plan in Columbia and the Custom Network Plan in St. Louis (i.e., your official business unit is located in an eligible Columbia-only county but your home address is in an eligible St. Louis-area county, or vice versa). In this case, you will have the option to enroll in either of the two insurance plans. Please note, however, that these plans have access to different networks of medical care providers. You will only have in-network access to those providers associated with the particular plan in which you choose to enroll.

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.

• Your network consists primarily of providers affiliated with University of Missouri Health Care, with services such as:
  • Virtual Visits: Connect with a doctor via video on your mobile device, tablet or computer for a $15 copay.
  • Mizzou Doc Fast Pass: Establish care with in-network primary care physicians/specialists or get expedited access when scheduling primary care appointments by calling (573) 884-0432.
  • Mizzou Quick Care: For same-day sick care appointments for minor health issues (ages 2 and above), visit an in-network quick care clinic for $15. Visit MU Health's Mizzou Quick Care webpage for more.
  • HEALTHConnect: A patient portal connects you to MUHC providers and services.
• Mizzou pharmacy is the preferred network pharmacy for retail and 90-day prescriptions, but members have access to Express Scripts’ nationwide network. Participants may fill specialty medications through a Mizzou Specialty Pharmacy or Accredo.

• Your network consists primarily of providers affiliated with Mercy Health System, with services such as:
  • Mercy Care Management: Every provider and case manager is connected to the same electronic medical record, allowing for in-the-moment collaboration to ensure you get the right care at the right time.
  • Virtual Visits: Connect with a doctor via video on your mobile device, tablet or computer for a $15 copay. 
  • Mercy on Call: Provides you with real-time guidance and support for your condition. If you call your Mercy primary care provider when they are unavailable (e.g., after hours and weekends), you will be automatically connected to this service.
• Pharmacy coverage is provided by Express Scripts with access to pharmacies nationwide and mail order services. Specialty medications must be filled through Accredo.

Monthly employee premium cost* for active employees:

• Self only: $96
• Self and spouse: $271
• Self and child(ren): $253
• Self, spouse and child(ren): $457

*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.

What you pay for covered services varies based on whether the provider is in-network or out-of-network:

^^For labs and x-ray, “Basic” includes services such as x-ray, blood work, lipid panel, etc. “Advanced” includes services such as CT scan, PET scan, MRI, etc.

**Refer to the Summary Plan Description (SPD) for additional details on allowable and eligible expenses when using an out-of- network provider.

• 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**
• 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**
• 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**

* 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.

The Custom Network Plan has two annual deductibles: one for medical and a second for prescription drug costs.

• Medical deductible:
  • In-network: $200/self*; $600/family
  • Out-of-network: $1,500/self*; $4,500/family*
• Rx deductible:
  • Retail: $50/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.

The Custom Network 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.

If you enroll in the Custom Network 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.

To estimate prescription costs, visit Express Script's prescription cost estimator tool (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.

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.

Understanding your custom network of providers

The narrow network of providers for Columbia and St. Louis are different. A narrow network offers a smaller pool of in-network providers in exchange for decreased premium or service costs. You will only have in-network access to providers associated with the plan in which you enroll. That is, enrolling in the Columbia plan makes only Columbia’s narrow network available to you, and enrolling in the St. Louis plan makes only St. Louis’s network available to you.

You may be eligible for both the Custom Network Plan in Columbia and St. Louis (i.e., your official business unit is located in an eligible Columbia-area county but your home address is in an eligible St. Louis-area county, or vice versa). In this case, you may enroll in either of the two plans. However, you will still only have in-network access to providers associated with the plan in which you enroll.

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

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 preventive care guidelines (exit UM System site).

Special Health Topics

Consult the following webpages for additional information on special health topics:

• Autism
• Behavioral Health
• Diabetes
• Hearing

Visit the health and wellness tools and discounts webpage to maximize your convenience and savings.

• A custom network offers a smaller pool of in-network providers in exchange for decreased premium or service costs. See eligibility below for which version(s) of the plan are available to you.
  • The narrow network of providers for Columbia and St. Louis are different.
  • You only have in-network access to providers associated with the version of the plan in which you enroll.
• 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 eligible coinsurance and copayment expenses for the rest of the calendar year.
• You may 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.

If you are a benefit-eligible faculty or staff member with a home address or official business unit in an eligible region around Columbia or St. Louis, the Custom Network Plan is available to you. Counties are different for the Columbia and St. Louis plans, as follows:

• Columbia: There are eligible counties in mid-Missouri.
  • Missouri counties: Audrain, Boone, Callaway, Cole, Cooper, Howard, Moniteau, Osage and Randolph.
  • See the Columbia CNP coverage map (PDF, 109KB).
• St. Louis: There are eligible counties in both Missouri and Illinois.
  • Missouri counties: Franklin, Gasconade, Jefferson, Lincoln, Montgomery, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, and Washington.
  • Illinois counties: Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Pike, Randolph and St. Clair.
  • See the St. Louis CNP coverage map (PDF, 140KB)

You may be eligible for both the Custom Network Plan in Columbia and the Custom Network Plan in St. Louis (i.e., your official business unit is located in an eligible Columbia-only county but your home address is in an eligible St. Louis-area county, or vice versa). In this case, you will have the option to enroll in either of the two insurance plans. Please note, however, that these plans have access to different networks of medical care providers. You will only have in-network access to those providers associated with the particular plan in which you choose to enroll.

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.

• Your network consists primarily of providers affiliated with University of Missouri Health Care, with services such as:
  • Virtual Visits: Connect with a doctor via video on your mobile device, tablet or computer for a $15 copay.
  • Mizzou Doc Fast Pass: Establish care with in-network primary care physicians/specialists or get expedited access when scheduling primary care appointments by calling (573) 884-0432.
  • Mizzou Quick Care: For same-day sick care appointments for minor health issues (ages 2 and above), visit an in-network quick care clinic for $15. Visit MU Health's Mizzou Quick Care webpage for more.
  • HEALTHConnect: A patient portal connects you to MUHC providers and services.
• Mizzou pharmacy is the preferred network pharmacy for retail and 90-day prescriptions, but members have access to Express Scripts’ nationwide network. Participants may fill specialty medications through a Mizzou Specialty Pharmacy or Accredo.

• Your network consists primarily of providers affiliated with Mercy Health System, with services such as:
  • Mercy Care Management: Every provider and case manager is connected to the same electronic medical record, allowing for in-the-moment collaboration to ensure you get the right care at the right time.
  • Virtual Visits: Connect with a doctor via video on your mobile device, tablet or computer for a $15 copay. 
  • Mercy on Call: Provides you with real-time guidance and support for your condition. If you call your Mercy primary care provider when they are unavailable (e.g., after hours and weekends), you will be automatically connected to this service.
• Pharmacy coverage is provided by Express Scripts with access to pharmacies nationwide and mail order services. Specialty medications must be filled through Accredo.

Monthly employee premium cost* for active employees:

• Self only: $92
• Self and spouse: $259
• Self and child(ren): $242
• Self, spouse and child(ren): $437

*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.

What you pay for covered services varies based on whether the provider is in-network or out-of-network:

^^For labs and x-ray, “Basic” includes services such as x-ray, blood work, lipid panel, etc. “Advanced” includes services such as CT scan, PET scan, MRI, etc.

**Refer to the Summary Plan Description (SPD) for additional details on allowable and eligible expenses when using an out-of- network provider.

• 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**
• 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**

* 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.

The Custom Network Plan has two annual deductibles: one for medical and a second for prescription drug costs.

• Medical deductible:
  • In-network: $200/self*; $600/family
  • Out-of-network: $1,500/self*; $4,500/family*
• Rx deductible:
  • Retail: $50/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.

The Custom Network 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.

If you enroll in the Custom Network 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.

To estimate prescription costs, visit Express Script's prescription cost estimator tool (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.

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.

Understanding your custom network of providers

The narrow network of providers for Columbia and St. Louis are different. A narrow network offers a smaller pool of in-network providers in exchange for decreased premium or service costs. You will only have in-network access to providers associated with the plan in which you enroll. That is, enrolling in the Columbia plan makes only Columbia’s narrow network available to you, and enrolling in the St. Louis plan makes only St. Louis’s network available to you.

You may be eligible for both the Custom Network Plan in Columbia and St. Louis (i.e., your official business unit is located in an eligible Columbia-area county but your home address is in an eligible St. Louis-area county, or vice versa). In this case, you may enroll in either of the two plans. However, you will still only have in-network access to providers associated with the plan in which you enroll.

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

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 preventive care guidelines (exit UM System site).

Special Health Topics

Consult the following webpages for additional information on special health topics:

• Autism
• Behavioral Health
• Diabetes
• Hearing

Visit the health and wellness tools and discounts webpage to maximize your convenience and savings.