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Medical Plans

State Employees

MCHCP offers three health plan options that include medical coverage administered by Anthem, and prescription drug coverage administered by Express Scripts. Each option offers the same nationwide networks. You can access non-network providers, too. Network preventive services are paid at 100%.

The HSA Plan is a qualified high-deductible plan that can help you save money by giving you access to a health savings account (HSA). On the HSA Plan, you will pay all medical and prescription drug expenses until your individual deductible is met — then you will usually pay coinsurance. MCHCP offers two PPO plans – the PPO 1250 Plan and PPO 750 Plan. The plan names come from the individual deductible amounts associated with them — $1,250 for the PPO 1250 Plan and $750 for the PPO 750 Plan. Under our PPO plans, most services are subject to deductible and coinsurance. There are also some services covered at no cost to MCHCP members.

Medical Plans Overview

	Health Savings Account (HSA) Plan		PPO 1250 Plan		PPO 750 Plan
Benefit Description	Network	Non-Network	Network	Non-Network	Network	Non-Network
Deductible (must meet deductible before coinsurance)	$1,800/individual $3,600/family	$3,300/individual $6,600/family	$1,250/individual $2,500/family	$2,500/individual $5,000/family	$750/individual $1,500/family	$1,500/individual $3,000/family
Medical Out-of-Pocket Maximum	$5,400/individual $10,800/family	$9,900/individual $19,800/family	$3,750/individual $7,500/family	$7,500/individual $15,000/family	$2,250/individual $4,500/family	$4,500/individual $9,000/family
Preventive Services	MCHCP pays 100%	40% coinsurance	MCHCP pays 100%	40% coinsurance	MCHCP pays 100%	40% coinsurance
Office Visit	20% coinsurance	40% coinsurance	Primary Care or Mental Health: $25 copayment Specialist: $40 copayment Chiropractor: $20 copayment or 50% of total cost of service, whichever is less	40% coinsurance	20% coinsurance	40% coinsurance
Virtual Care through Sydney Health, Hinge Health, and Lark’s Virtual Diabetes Prevention Program	MCHCP pays 100%	N/A	MCHCP pays 100%	N/A	MCHCP pays 100%	N/A
Urgent Care	20% coinsurance	Paid as Network Benefit	$50 copayment	Paid as Network Benefit	20% coinsurance	Paid as Network Benefit
Emergency Room	20% coinsurance	Paid as Network Benefit	$250 copayment plus 20% coinsurance	Paid as Network Benefit	$250 copayment plus 20% coinsurance	Paid as Network Benefit
Hospital (Inpatient)	20% coinsurance	40% coinsurance	$200 copayment plus 20% coinsurance	$200 copayment plus 40% coinsurance	$200 copayment plus 20% coinsurance	$200 copayment plus 40% coinsurance
Lab and X-ray	20% coinsurance	40% coinsurance	20% coinsurance	40% coinsurance	20% coinsurance	40% coinsurance
Surgery	20% coinsurance	40% coinsurance	20% coinsurance	40% coinsurance	20% coinsurance	40% coinsurance

* MCHCP will annually contribute to the HSAs of active employees $500 for individual coverage and $1,000 for family coverage.

Missouri state law, Section 191.724, RSMo, allows a person the right to decline or refuse coverage for contraception if these items or procedures are contrary to an employee’s religious beliefs or moral convictions.

Medical Plan Videos

MCHCP has created videos to help explain insurance terms and descriptions, and to educate members about our medical plan benefit options.

MCHCP is constantly evaluating the best way to communicate with its members. MCHCP currently utilizes Google’s YouTube service to host informational videos. We understand that not all state agencies allow content from YouTube through their approved content web filters. Please see your respective IT department for help in gaining access to our video content or review them from a device connected by a non-state internet service provider.

Medical Plans

Medical Plans Overview

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