Medical Insurance

The University’s self-funded medical plan is available to eligible employees. Claims are processed by a third-party administrator, Med-Pay Inc. The university pays over 90% of the employee’s monthly premium. In addition, a portion (up to $360 annually) can be waived with participation in the designated wellness activities, making this benefit even more valuable to you. Refer to the tables below for details.


Cost and coverage

2024 Base Plan 

Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium

Employee only

$552.52

42.00

$0.00

$594.52

Employee + spouse

$872.67

$42.00

$357.00

$1271.67

Employee + child(ren)

$798.96

$42.00

$252.00

$1092.96

Employee + family

$1313.09

$42.00

$415.00

$1770.09

*Monthly premium will be reduced up to $30 for employee who qualify by participating in the designated wellness activities.

2024 Buy-up Plan 
Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium

Employee only

$597.14

$93.00

$0.00

$690.14

Employee + spouse

$965.58

$93.00

$418.00

$1476.58

Employee + child(ren)

$880.79

$93.00

$295.00

$12068.79

Employee + family

$1478.25

$93.00

$486.00

$2055.25

*Monthly premium will be reduced up to $30 for employee who qualify by participating in the designated wellness activities.

Services covered

 Refer to the summary plan document for complete covered services information.  Covered services include comprehensive medical and prescription services including Mental health.

Covered Preventive Services received at Magers Health and Wellness Center and/or In-Network Providers will be paid 100% by the plan.

  • If a Covered person is seeking services by a Wrap or Non-Network provider when services are available in the network area by a Network provider, prior to seeking services, the Network provider in that specialty must submit a referral to the Utilization Review Coordinator to determine if the services will be considered under the Network Provider Benefit & the time period for which the services will be approved under this exception.
  • If a Covered person is seeking Mercy Tertiary Network Provider in the Mercy extended PPO coverage area outside Southwest Missouri, a referral is required and musst be submitted to the Utilization Review coordinator for approval. If approved, the Network provider benefit will apply.
  • See the plan document for further plan information, limitations, and exceptions.

Prescription coverage

  • Elixir is our Pharmacy Benefit Manager (PBM).
  • The Base Plan maximum out of pocket for prescriptions is $2000 individual/$4000 family. 
  • The Buy-Up plan maximum out of pocket for prescriptions will be $1500 individual/$3000 family.

Both base and buy-up plans participate in the following RX programs:

Generic Incentive Covered expenses are limited to the cost of a generic drug if an equivalent generic drug is available when a multi-source brand name drug is dispensed. In addition to the coinsurance, the covered person must pay the difference between the cost of the generic drug and the multi-source brand name drug.  This is a significant increase in the incentive to use generic drugs when available and has been necessary to reduce unnecessary pharmaceutical costs to the health plan.

Other Copay Rules: Brand drugs that have a generic equivalent will be 50% coinsurance at retail pharmacy AND at Magers Pharmacy. All other drugs filled at Magers Pharmacy will have 20% coinsurance. 

Step Therapy - This program requires you to try a particular drug that is cheaper before you can move to a more expensive choice.  However, if you have already tried the cheaper drug without benefit, you will not have to try it again if you obtain documentation from your doctor.

Members may save an additional 10% when receiving prescriptions at Magers pharmacy. Members may also save by utilizing the mail order service as well.

Enrolling and making changes

You must enroll, and select dependent coverage options, within 30 days of your start date. **Premiums are paid ahead monthly. Your coverage will start the first of the month following date of hire. (example: coverage starts 7/1 premium is due from June payroll)

Once enrolled, changes may only be made yearly during Open enrollment, or within 31 days of a qualifying event. Qualifying events include loss or gain of coverage (add/drop of like coverage) Marriage (add newly eligible dependents), divorce (drop non qualifying dependents), birth/adoption (add new dependent). Qualifying event change request must include supporting documentation for verification of the qualifying event. Changes will be made effective the first of the month following receipt of the request and all supporting documentation for event change requests other than birth.  For more information, contact human resources.

Declining Coverage

You have the option to decline the medical insurance coverage. If you decline the university’s medical coverage for yourself, you are also declining coverage for your family members. Declining the coverage does not result in a payment or increase in your salary in lieu of coverage.

Access Your Information

Through My Mercy, you have direct access to your medical records, including test results and immunizations. This resource also gives you a direct line to your physician’s office to schedule appointments, request medication refills or ask medical questions from Mercy providers.

Through Med-pay you will be able to view and reprint your explanation of benefits (EOBs), view your claim history, see detailed information related to your claims, view deductible and coinsurance accumulators, and contact Med-Pay Customer Service. There is also a claims summary CSV file download available. Additional features will be added over the coming months, including the ability to request and view your ID card.

How to File a Claim

If you’re enrolled in the university’s cafeteria plan, follow the instructions on this form to submit a medical claim or to submit a pharmacy claim form.

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