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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

Coverage, as required by Missouri law, limited to prostheses and expenses for scalp hair prostheses worn for hair loss are covered for alopecia areata or alopecia totalis for children 18 years of age or younger.

The annual maximum is $200. The lifetime maximum is $3,200. A one-time expense of up to $3,200 may be requested.

Benefits expire when a total of $3,200 has been spent or the member reaches 19 years of age.


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