Classic Choice is a comprehensive health coverage plan that includes hospitalization, medical and prescription benefits.
MOFB Health Plans uses UnitedHealthcare Choice Plus Network. Please keep in mind that in-network payments are based on negotiated fees. If an out-of-network provider is used, the member’s liability will increase significantly.
Resources
Calendar Year Deductible(CYD)
Unless otherwise indicated, all benefits are subject to CYDOption 2: $6,000 Per Individual
OUT-OF-POCKET (OOP) MAXIMUM
Once the OOP maximum is met, eligible benefits are provided at 100% for an individual for the remainder of the calendar year. This applies to In-Network provider services only. Copayments do not apply to OOP and must still be paid after OOP is met.Option 2: $20,000 Per Individual
LIFETIME BENEFIT MAXIMUM
OFFICE VISIT
Not subject to CYDTELADOC
Not subject to CYDCOINSURANCE
(After CYD and based on maximum allowable charge)Plan Pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
NO WAITING PERIOD. In-network benefits not subject to CYD.
Preventative Health Exam1
Plan Pays: 100%
Plan Pays: 60%
Your Responsibility: 40%
Annual Well Woman Exam2
Plan Pays: 100%
Plan Pays: 60%
Your Responsibility: 40%
Routine Colonoscopy3
Plan Pays: 100%
Plan Pays: 60%
Your Responsibility: 40%
Annual Routine PSA4
Plan Pays: 100%
Plan Pays: 60%
Your Responsibility: 40%
Unlimited Calendar Year Maximum Per Member
Generic 30 day supply
Plan pays: All but Copay
Your Responsibility: $4 Copay5
Plan Pays: 60%
Your Responsibility: 40%
Brand - Subject to deductible
Plan Pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
EMERGENCY ROOM SERVICES
(Not resulting in admission)
$300 Deductible Per Visit
(In addition to CYD and Coinsurance)
DENTAL - No waiting periods
Pediatric (Under Age 19)
- Preventative services as outlined by the United States Preventive Services Task Force (USPSTF) and the Health Resources and Service Administration (HRSA)
- Other eligible dental services subject to CYD and coinsurance
- Limited orthodontic care
Age 19 and Over
- There is a $45 copay for preventative and restorative services
- Maximum benefit per calendar year is $500
VISION
Pediatric (Under Age 19)
Benefits include eye exams, eyeglasses and contact lenses
- No waiting period
- Eye exams are covered at 100% once every calendar year, no dollar limit
- Eyeglass frames, lenses or contact lenses are covered once every calendar year at 100% up to a maximum of $100 per individual, not subject to deductible and coinsurance
Age 19 and Over
Benefits include eye exams, eyeglasses and contact lenses
- Eye exams are covered once every calendar year with a limit of $40
- Eyeglass frames, lenses or contact lenses are covered once every calendar year at 100% up to a maximum of $100 per individual, not subject to deductible and coinsurance
FOOTNOTES
-
Preventative health exam for adults and children, including associated services, are provided by a physician, either directly during the exam or
through appropriate referrals including:
- Screenings and counseling services with an A or B recommendation by the United States Preventive Services Task Force (USPSTF)
- Bright Futures recommendations for infants, children and adolescents supported by the Health Resources and Services Administration (HRSA)
- Preventative care and screening for women as provided in the guidelines supported by HRSA, and Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) that have been adopted by the Centers for Disease Control and Prevention (CDC)
-
Annual Well Woman:
- Routine well woman preventative exam office visit
- Cervical cancer screening
- Screening mammography at age 40 and older, with one baseline mammogram between the ages of 35 and 39
-
Other USPSTF screenings with
an A or B rating
- Pap smears
- Bone density measurement screening
- One routine colonoscopy every ten years for individuals age 45 and older
- Prostate cancer screening for men age 50 and older
- Prescription copayments do not apply toward deductibles or out-of-pocket maximums
Benefits will not be provided for any pre-existing condition until an individual has completed a waiting period of at least six months. A pre-existing condition is defined in the contract as “An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this contract for which: Medical advice or treatment was recommended by or received from a provider of health care services, or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment.”
Copayments will be applied to each office visit for the covered services performed in the office and provided and billed by a physician who is an In-Network provider. The remaining charges for covered services rendered during the office visit will be paid at 100% of the maximum allowable charge. If a physician who is an Out-of-Network provider is utilized for covered services, benefits will be determined on the basis of an Out-of-Network coinsurance percentage after deductible is met.
Copayments do not apply to the following services: advanced radiological imaging, allergy testing and injections, biopsy interpretation, bone density testing, cardiac diagnostic testing, chemotherapy services, chiropractic services, complex diagnostic services, dental services except preventative and restorative for all individuals age nineteen (19) and over, diagnostic services sent out, durable medical equipment, growth hormone injections, IV therapy, Lupron injections, mammography, maternity services, nerve conduction studies, neuropsychological or neurological tests, nuclear cardiology, nuclear medicine, orthotics, preventative services as indicated in the contract, prosthetics, provider administered specialty pharmacy products, sleep studies, surgery performed in a physician’s office and related surgical supplies, Synagis injections, therapeutic/rehabilitative/habilitative services, ultrasounds and vision services. These services are subject to the terms and conditions of the contract and deductibles and coinsurance will apply except where otherwise indicated. Copayments will not be applied to the deductibles or basis of an Out-of-Network.
Maternity benefits will be eligible as long as the pregnancy is not considered a pre-existing condition.
Access to Missouri Farm Bureau Health Plans is a benefit of being a member of Missouri Farm Bureau. You must be a member for at least 30 days before applying for individual, family, and or dental and vision plans.
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