Medical Insurance

The University offers a self-funded medical plan for eligible employees, with claims managed by Med-Pay Inc. The university covers over 90% of the monthly premium, and participation in wellness activities can waive up to $360 annually. Refer to the tables below for more details.

Find participating providers

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

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

**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. 

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 (Domestic Partner*)

$965.58 +

$93.00 +

$418.00 =

$1476.58

Employee + child(ren)

$880.79 +

$93.00 +

$295.00 =

$1268.79

Employee + family

$1478.25 +

$93.00 +

$486.00 =

$2055.25

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

**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. 

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 must 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 within 31 days of your start date. Premiums are paid monthly in advance (example: coverage starts on July 1, the premium will be deducted from your June payroll).

Changes can be made annually during Open Enrollment or within 31 days of a qualifying event (e.g., marriage, divorce, birth, or loss/gain of coverage) with supporting documentation. Changes take effect the first of the month after documentation is received, except for birth-related changes. Contact Human Resources for details.

Qualifying life event change form

Declining Coverage

Employees may decline the MSU medical plan and opt to purchase plans on the Health Insurance Marketplace (Health Insurance Exchange) under ACA rules. Re-enrollment is permitted only during open enrollment or within 31 days of a qualifying life event.

Declining the coverage does not result in a payment or increase in your salary in lieu of coverage.

Access Your Information

With My Mercy, you can access your medical records, schedule appointments, request refills, and contact your Mercy physician.

Med-pay  lets you view and reprint EOBs, track claims, see deductible info, request a duplicate or depednent ID card, and contact customer service. A claims summary download is also available.

Group Number 090188MSU

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.

Policy

Forms and publications

Forms

Publications

Contact information

Person item component: deidremings
Loading Profile. . .
loading
Person item component: dlofton
Loading Profile. . .
loading
Person item component: paulajhuey
Loading Profile. . .
loading