Looking for a Health Savings Account (HSA) qualified plan? Missouri Farm Bureau Health Plans offers a range of High Deductible Health Plans (HDHP) which meet all federal requirements necessary to open an HSA.
Missouri Farm Bureau Health Plans uses UnitedHealthcare ChoicePlus 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.
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Calendar Year Deductible1 (CYD)
Unless otherwise indicated, all benefits are subject to CYD. Family Deductible can be satisfied by one or more covered individual during a calendar year. In-Network and Out-of-Network deductibles are met separately.$3,750 Per Individual
$4,500 Per Family
$7,500 for 2-Person, 3-Person or Family with 4+ Individuals
OUT-OF-POCKET (OOP) MAXIMUM2
Family OOP maximum can be satisfied by one or more covered individual during a calendar year. 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.$5,625 for $3,750 CYD
$9,000 for $4,500 CYD
$11,250 for $7,500 CYD
LIFETIME BENEFIT MAXIMUM
FOOTNOTES
- Deductible – the dollar amount of covered services that must be incurred and paid first by an individual each calendar year before plan benefits begin.
- Once the OOP maximum is met, benefits are provided at 100% for an individual for the remainder of the calendar year. This applies to In-Network provider services only. There is no out-of-pocket maximum when Out-of-Network providers are used.
COINSURANCE
(After CYD and based on maximum allowable charge)Plan Pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
TELADOC
Individual must pay 100% of current Teladoc consultation fee until CYD is met. Once CYD is met, no consultation fee for Teladoc.PREVENTATIVE CARE BENEFITS
(Subject to CYD)
Well Child Services3
Plan Pays: 80%
Your Responsibility: 20%
Not Covered
Routine Colonoscopy4
Plan Pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
Annual Routine PSA5
Plan Pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
Annual Routine OB/GYN Exam6
Plan Pays: 80%
Your Responsibility: 20%
Not Covered
Annual Routine Pap Smear7
Plan Pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
Mammogram8
Plan Pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
(Subject to CYD)
Generic & Brand Prescriptions
Unlimited Calendar Year Maximum Per Individual
Home Delivery Services Are Available
Plan pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
FOOTNOTES
-
Benefits are available, subject to deductible and coinsurance, for an individual under the age of 7 (on plan deductibles $4,500 and $7,500) for
physical examinations and appropriate immunizations/vaccinations when services are rendered by an In-Network provider. Exams not used during
the time periods below do not carry over to the next time period.
- Under Age 1 - Four exams from birth to the child's first birthday
- Age 1 - Two exams from the child's first birthday to the child's second birthday
- Age 2 through 6 - One exam per year (determined by the child's birthday)
- Benefits will be provided for one routine colonoscopy every ten years for individuals age 45 and older when provided by an In-Network or Out-of-Network provider, subject to the deductible and coinsurance.
- Benefits will be provided, subject to deductible and coinsurance, for one routine PSA per calendar year when services are rendered by an independent laboratory or other outpatient setting.
- Benefits will be available for one routine OB/GYN exam per calendar year, subject to deductible and coinsurance. Services must be rendered by an In-Network physician’s office and billed by the In-Network provider. Related pathology, including pap smear, which is provided as a part of the routine OB/GYN exam, will be covered when the services are rendered by an In-Network physician’s office and billed by the In-Network provider. Related pathology that the physician sends to an independent laboratory will be subject to deductible and coinsurance. No benefit is available for routine OB/GYN exams provided by an Out-of-Network provider.
- Benefits will be provided for the interpretation of one routine pap smear per calendar year when services are rendered by an independent laboratory or other outpatient setting, subject to deductible and coinsurance.
- For routine mammography screening provided such examinations are conducted upon the recommendation of the individual’s physician. One baseline routine mammogram will be allowed for individuals between the ages of 35-39. One routine mammogram will be allowed annually for individuals age 40 and above. All routine mammography screens are subject to deductible and coinsurance.
- Benefits will be provided, subject to deductible and coinsurance.
Benefits will not be provided for any pre-existing condition until an individual has completed a waiting period of at least 12 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.”
Maternity benefits will be available after an individual’s coverage on a 2-person, 3-person or family contract has been in effect for nine consecutive months. Individual coverage has NO maternity benefits.
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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