The Retiree Health PPO Plan is available to retirees and their dependents who are not yet eligible for Medicare.
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.
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2025 Retiree Health PPO
Costs
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💲 Premiums
Your share of insurance premiums is determined by a formula that considers your age and years of service at retirement and the program under which your benefits are payable. For more information about retiree insurance eligibility and premiums, visit the Retiree benefits overview webpage.
For additional details, see the SPD for this plan on the All Summary Plan Description (SPD) Documents webpage.
🩺 Covered Services
What you pay for covered services varies based on whether the provider is in-network or out-of-network:
In-Network Services
|
Out-of-Network Services**
|
**Refer to the Summary Plan Description (SPD) for additional details on allowable and eligible expenses when using an out-of- network provider.
➖ Deductible
The Retiree Health PPO Plan has two annual deductibles: one for medical and a second for prescription drug costs.
- Medical deductible:
- In-network: $1,500/self*; $4,500/family*
- Out-of-network: $4,000/self*; $12,000/family*
- Rx deductible: $75/person
🧾 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: $4,500/self*; $9,000/family*
- Out-of-network**: $8,000 or more/self; $16,000 or more/family*
- Rx out-of-pocket limit: $3,800/self; $7,600/family
💊 Prescription Drugs
- Prescription drug: Retail:
- In-network: Greater of (after $75 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**: 50% coinsurance or more; minimum $30**
- In-network: Greater of (after $75 Rx deductible):
- Prescription drug: Maintenance:
- In-network: Greater of:
- Formulary generic: $10 copay or 25% coinsurance
- Formulary brand: $20 copay or 30% coinsurance
- Non-formulary brand: $40 copay or 55% coinsurance
- Out-of-network**: 50% coinsurance or more; minimum $30**
- In-network: Greater of:
- 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**: 50% coinsurance or more; minimum $30**
- In-network: Greater of:
* 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.
Making the Most of Your Plan
Click on a header to expand the selection and uncover additional information.
📋 Preauthorization
In some cases, prior authorization is necessary for non-emergency use of certain facilities, diagnostic testing, and other health services before care is provided. The Retiree Health PPO Plan uses the same preauthorization list as the active-employee insurance plans.
🏥 Network Providers
You may choose to visit either in-network or out-of-network doctors 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.
🧑⚕️ Choose the Right Type of Care
Making an informed decision about your healthcare needs can save you time and money, but when you are ill or injured, assessing your condition and choosing the best place to go for treatment isn’t easy. You have four care options, but each is unique in the services it provides.
Primary care physician
Visit your primary care physician when you have a non-life threatening condition during regular hours of work week, or if you don’t need immediate attention. It’s always best to see your primary care physician, since they know you and your health history.
- Examples include: Persistent cough; sore throat or rash; minor injuries or aches
Convenience care clinic
When you experience symptoms where you would normally see a primary care physician, but it’s after hours or on a weekend, a convenience care clinic can be a good option. Convenience care clinics are typically available in local retail or drug stores and usually have extended hours on weekdays and weekends.
- Examples include: Persistent cough; sore throat or rash; minor injuries or aches
Urgent care clinic
Urgent care clinics are an appropriate choice when you have an unexpected illness or injury that requires immediate attention but is not necessarily life-threatening. These clinics offer many resources to treat a wound or injury and will often do so immediately.
- Examples include: A cut that may need stitches; a sprained ankle
Emergency room
Seek an emergency room when an illness or injury is very serious or life-threatening. In most cases, you will know the condition is serious, sudden and/or requires immediate attention. If you are unable to get to an emergency room, call 9-1-1 for assistance.
- Examples include: Broken bones with deformed appearances; head trauma; drug or alcohol overdoses; severe cuts or burns.
🎗 Preventive Care and Special Health Topics
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:
* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.
2024 Retiree Health PPO
Costs
Click on a header to expand the selection and uncover additional information.
💲 Premiums
Your share of insurance premiums is determined by a formula that considers your age and years of service at retirement and the program under which your benefits are payable. For more information about retiree insurance eligibility and premiums, visit the Retiree benefits overview webpage.
For additional details, see the SPD for this plan on the All Summary Plan Description (SPD) Documents webpage.
🩺 Covered Services
What you pay for covered services varies based on whether the provider is in-network or out-of-network:
In-Network Services
|
Out-of-Network Services**
|
**Refer to the Summary Plan Description (SPD) for additional details on allowable and eligible expenses when using an out-of- network provider.
➖ Deductible
The Retiree Health PPO Plan has two annual deductibles: one for medical and a second for prescription drug costs.
- Medical deductible:
- In-network: $1,000/self*; $2,500/family*
- Out-of-network: $2,100/self*; $5,100/family*
- Rx deductible: $75/person
🧾 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: $4,000/self*; $8,000/family*
- Out-of-network**: $6,000 or more/self; $12,000 or more/family*
- Rx out-of-pocket limit: $3,800/self; $7,600/family
💊 Prescription Drugs
- Prescription drug: Retail:
- In-network: Greater of (after $75 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**: 50% coinsurance or more; minimum $30**
- In-network: Greater of (after $75 Rx deductible):
- Prescription drug: Maintenance:
- In-network: Greater of:
- Formulary generic: $10 copay or 25% coinsurance
- Formulary brand: $20 copay or 30% coinsurance
- Non-formulary brand: $40 copay or 55% coinsurance
- Out-of-network**: 50% coinsurance or more; minimum $30**
- In-network: Greater of:
- 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**: 50% coinsurance or more; minimum $30**
- In-network: Greater of:
* 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.
Making the Most of Your Plan
Click on a header to expand the selection and uncover additional information.
📋 Preauthorization
In some cases, prior authorization is necessary for non-emergency use of certain facilities, diagnostic testing, and other health services before care is provided. The Retiree Health PPO Plan uses the same preauthorization list as the active-employee insurance plans.
🏥 Network Providers
You may choose to visit either in-network or out-of-network doctors 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.
🎗 Preventive Care and Special Health Topics
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:
* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.
Reviewed 2025-02-11
