Medical Insurance

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Cost and coverage

2025 Base Plan

Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium
Employee only $604.20 + 44.00 + $0.00 = $648.20
Employee + spouse $966.49 + $44.00 + $376.00 = $1386.49
Employee + child(ren) $881.64 + $44.00 + $266.00 = $1191.64
Employee + family $1448.91 + $44.00 + $437.00 = $1929.91

2026 Base Plan

Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium
Employee only $676.05 + 48.00 + $0.00 = $724.05
Employee + spouse $1090.74 + $48.00 + $410.00 = $1548.74
Employee + child(ren) $993.08+ $48.00 + $290.00 = $1331.08
Employee + family $1631.75+ $48.00 + $476.00 = $2155.75

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

*Domestic Partner coverage requires completed affidavit.

2025 Buy-up Plan 

Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium
Employee only $655.74 + $98.00 + $0.00 = $753.74
Employee + spouse (Domestic Partner*) $1073.66 + $98.00 + $441.00 = $1612.66
Employee + child(ren) $976.72 + $98.00 + $311.00 = $1385.72
Employee + family $1636.66 + $98.00 + $510.00 = $2244.66

2026 Buy-up Plan

Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium
Employee only $730.67+ $107.00 + $0.00 = $837.67
Employee + spouse (Domestic Partner*) $1203.23 + $107.00 + $482.00 = $1792.23
Employee + child(ren) $1093.02 + $107.00 + $340.00 = $1540.02
Employee + family $1830.60+ $107.00 + $557.00 = $2494.60

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

*Domestic Partner coverage requires completed affidavit.

Covered Services 🏥

  • Comprehensive medical and prescription coverage, including mental health

  • Preventive services at Magers Health & Wellness Center or In-Network providers are 100% covered

  • Non-network or wrap providers: Referral required if services are available in-network; must be approved by Utilization Review Coordinator

  • Mercy Tertiary Network (outside SW Missouri): Referral required for Network benefit approval

  • See plan document for full details, limitations, and exceptions

Prescription Coverage 💊

Pharmacy Benefit Manager: Med-Impact

Out-of-pocket maximums:

  • Base Plan: $2,000 individual / $4,000 family

  • Buy-Up Plan: $1,500 individual / $3,000 family

Programs & Rules:

  • Generic Incentive: Use generics when available; pay the difference if choosing a multi-source brand. FAQ's 

  • Brand Drugs with Generic Equivalent: 50% coinsurance at retail or Magers Pharmacy

  • Other Drugs at Magers Pharmacy: 20% coinsurance 

  • Other Drugs at Med-impact Pharmacy: 30% coinsurance

  • Step Therapy: Must try a lower-cost drug first unless your doctor documents prior attempt without benefit

  • Extra Savings: 10% discount at Magers Pharmacy + mail-order options

  • Speciality Medications

Enroll & Make Changes ✅

  • Deadline: Within 31 days of your start date

  • Premiums: Paid in advance (e.g., coverage starts July 1 → deducted from June paycheck)

  • Making Changes:

    • During Open Enrollment, or

    • Within 31 days of a qualifying life event (marriage, divorce, birth, coverage change)

    • Most changes take effect the first of the month after documentation (except births)

    • Qualifying Life Event Change Form

📞 Questions? Contact Human Resources

 

Declining Coverage ❌

  • You may waive MSU coverage and use the Health Insurance Marketplace

  • Re-enroll only during Open Enrollment or within 31 days of a qualifying life event

  • Important: Waiving coverage does not increase your salary

Access Your Info 💻

My Mercy:

  • View medical records

  • Schedule appointments

  • Request prescription refills

  • Contact your Mercy physician

Med-Pay:

  • Track claims & deductibles

  • View/reprint EOBs

  • Request duplicate or dependent ID cards

  • Download claims summaries

Group #: 090188MSU

Policy

Forms and publications

Forms

Publications

Flyers:

Contact information

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