Medical Insurance

The university’s self-funded medical plan is available to all eligible employees, spouses and eligible dependents at the low monthly rate of $30. But your monthly premium is waived if you participate in annual wellness activities — making medical insurance free to employees in 2018. Effective January 1, 2019,  employees will be responsible for a portion of their premiums. Refer to the tables below for details. 


2019 plan year

Cost and coverage

Base Plan 

Coverage

University pays for employees

Employee pays for self*

Employee pays for dependents

Total premium

Employee only

$440.51

$40.00

$0.00

$480.51

Employee + spouse

$647.79

$40.00

$340.00

$1027.79

Employee + child(ren)

$603.36

$40.00

$240.00

$883.36

Employee + family

$995.64

$40.00

$395.00

$1430.64

*This monthly premium will be waived $30 for employees who participate in the wellness activities.  

Buy Up Plan

Coverage

University pays for employees

Employee pays for self*

Employee pays for dependents

Total premium

Employee only

$431.49

$76.00

$0.00

$507.49

Employee + spouse

$669.80

$76.00

$340.00

$1085.80

Employee + child(ren)

$617.00

$76.00

$240.00

$993.00

Employee + family

$1040.31

$76.00

$395.00

$1511.31

*This monthly premium will be waived $30 for employees who participate in the wellness activities.

Services covered

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

Prescription coverage

  • MedTrak will still be our Pharmacy Benefit Manager (PBM) in 2019.
  • The Base Plan maximum out of pocket for prescriptions will be $2000. 
  • The Buy-Up plan maximum out of pocket for prescriptions will be $1500. 

2018 plan year

Cost and coverage

The following rates are for the 2018 calendar year:

Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium
Employee only $418.16 $30.00 $0.00 $448.16
Employee + spouse $553.16 $30.00 $320.91 $904.07
Employee + child(ren) $418.16 $30.00 $222.89 $671.05
Employee + family $553.16 $30.00 $363.20 $946.36

*This $30.00 monthly premium will be waived for employees who participate in the wellness activities.

Services covered

Missouri State wants you to be healthy, so when you need to see a physician, our medical insurance will lighten the load. See the medical insurance booklet to learn more about deductibles on a variety of services.

The university also provides a preventive benefit, e.g., annual physical, capped at $400 per covered person.

  • On campus office visits – The deductible is waived, and the insurance pays 100 percent of the cost up to the allowed $400.
  • Participating provider – The deductible is waived, and your responsibility is 20 percent coinsurance up to the allowed $400.
  • Non-participating provider – The deductible must be paid, and the patient’s responsibility is 40 percent coinsurance up to the allowed $400.
  • West Plains employees – The deductible is waived, and the insurance pays 100 percent of the cost up to the allowed $400 when you receive care from a network provider in the West Plains area.

Prescription coverage

When filling a prescription, show your medical/dental identification card to the pharmacist for discounts on prescription drugs. MedTrak Pharmacy Services offers retail and mail-order pharmacy services at reduced costs.

Filling prescriptions at Magers Health and Wellness Center’s pharmacy is not only convenient, but it saves you money, too. You only have to pay 20 percent.

Not using Magers Pharmacy? The prescription drug benefit requires a 30 percent coinsurance each time a prescription is filled through the year (an individual’s cap is $1,500 annually). Once you’ve paid the $1,500, all prescriptions filled for the remainder of the year are paid at 100 percent by the insurance plan. For families, the annual coinsurance amount is capped at $3,000.

The co-pay amounts for all prescription medications increase to 50 percent when the prescription is filled with a brand name drug and a generic equivalent drug is available and substitutable, as determined by the physician.


All plan years

Limits and exclusions

If you are hired after Sept. 1, you will initially have your employee premium waived until the next available opportunity to participate in wellness activities.

How to use the benefit

Your medical plan utilizes a Preferred Provider Organization (PPO) network, which outlines participating providers. However, it is your choice as to which provider to use.

The university also has an on-site healthcare facility, Magers Health and Wellness Center, that is convenient and affordable. The in-network $800 deductible is waived if you or your insured family member uses this facility.

To begin taking advantage of the prescription medicine insurance, simply notify your pharmacy. Check out a list of MedTrak acceptable pharmacies.

Enrolling and making changes

You must enroll, and select dependent coverage options, within 30 days of your start date.

Each fall, the university participates in open enrollment when you can make changes to your plan.

Outside of the open enrollment period, changes can only be made due to qualifying life events (like marriage, divorce or having a child). 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.

My Mercy

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.

Making claims

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.

Forms and publications

Forms

Publications

Policy

Contact information