PPO 750 Plan

Copayments
Members may pay a $250 copayment for emergency room services, in addition to deductible or coinsurance. This copayment is waived if the member is admitted to the hospital or the services are considered by the medical plan to be a “true emergency.” Even if the copayment is waived, the member will still have to pay any deductible or coinsurance owed for the Emergency Room service.

Members also have a $200 copayment for inpatient services in addition to their coinsurance.

Copayments apply to the out-of-pocket maximum, but not the deductible.

How the PPO 750 Plan Works

1. When visiting a health care provider, the member will pay for their medical expenses out of their pocket until the annual deductible is met. Members visiting an emergency room may also pay a $250 copayment (see Copayments section above).
2. Once the deductible is met, members will pay coinsurance on covered expenses until their out-of-pocket maximum is reached. At that time, the plan will begin paying 100% of covered services (see Family Coverage section below).
3. Active employees with a health care Flexible Spending Account (FSA) may receive reimbursement for qualified medical expenses by submitting a claim and providing necessary documentation to MoCAFE (see HSA vs FSA).

Family Coverage
If two or more family members are covered in a PPO plan and one family member reaches the individual deductible or out-of-pocket maximum, the medical plan begins paying claims for the individual. If one or more additional family members meet the individual deductible or out-of-pocket maximum, the medical plan begins paying claims for the entire family.

Two married active state employees who cover children may combine medical deductibles by participating in a Family Roll Up.

See Prescription Drug Plans for information on the prescription drug coverage and coinsurance/copayments.