The MOFB Health Plans Major Medical plan is ideal for those who want catastrophic protection with the advantage of a lower cost. This plan provides benefits for physician services, hospitalization, prescription drugs and more. Available for individuals or families.
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 Deductible1 (CYD)
Unless otherwise indicated, all benefits are subject to CYDOUT-OF-POCKET (OOP) MAXIMUM2
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.$30,000 Per Family
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%
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%
Unlimited Calendar Year Maximum Per Individual
Generic 30 day supply
Plan pays: All but Copay
Your Responsibility: $4 Copay9
Plan Pays: 60%
Your Responsibility: 40%
Brand - Subject to deductible
Plan Pays: 80%
Your Responsibility: 20%
Plan Pays: 60%
Your Responsibility: 40%
TELADOC
Not subject to CYDFOOTNOTES
-
Benefits are available, subject to deductible and coinsurance, for an individual under the age of 7 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 Outof-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.
- Benefits will be provided, 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.
- Prescription copayments do not apply toward deductible or out-of-pocket maximum.
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 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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