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What Missouri Districts Offer
The recent MSTA Benefit Survey shows the vast majority of districts do offer health
insurance to their employees. Most often, the district pays all or a substantial portion of the employee premium.
Here's a brief overview of the two most common health plans found in Missouri's school districts: PPO and HMO.
For details on these and other health plan options, see Types of Health Plans.
Preferred Provider Organization - PPO
With a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network.
However, when you go outside the network, you will pay more.
For example, a plan might pay 80% of the cost for a visit with an in-network doctor but
only 50% of the cost for a visit to a non-network doctor.
Most PPO plans also have an annual deductible.
Health Maintenance Organization - HMO
In an HMO, you'll select a primary care physician (also referred to as a PCP) from a list of doctors in that HMO's network.
The primary care physician will be the first medical provider to contact for a medical condition.
The PCP will make any needed referrals to a medical specialist.
Typically, these specialists will be in the HMO network.
When an employee obtains care without the primary care physician's referral or obtains care from a non-network member,
they may be responsible for paying the entire bill. (with exceptions for emergency care)
Typically, an HMO will not have an annual deductible.
Choices
Many districts will offer you a choice between the two types of plans. Others may offer a choice
between different PPO Plans ... often referred to as a core plan and a "buy up" option. The buy up option
will have better benefits (ie. lower deductible and coinsurance, wellness benefits, etc) - but it comes at
a higher price.
Which is right for you?
When evaluating health care plans for your District, there are many questions to consider to make an informed choice.
- Do you have an existing relationship with a doctor or hospital that you would like to continue?
- Do you want to be able to see a specialist without a referral?
- Are you more interested in low co-pays and deductibles?
- Are you looking for discounts for alternative health care such as vitamins, acupuncture or massage therapy
- How many doctors are there to choose from?
- Where are the offices and hospitals located?
- How are referrals to specialists handled?
- What hospitals are available through the plan?
- What arrangements does the plan have for emergency care?
- Are there limits on medical treatments or other services?
- What, if any, are the copayments for specific services?
- How much more will it cost to use non-network physicians?
- What is the deductible and coinsurance for non-network care?
If preserving an existing relationship with your physician is most important to you,
you may be better off with the PPO option. If, however, the lowest out of pocket cost is more appealing to
you, consider reviewing the HMO option. Bottom line - ask questions before you enroll in your
health plan.
Ask Questions
To become better informed about your District’s health insurance options, ask for (and read!) a copy of your health plan’s benefit summary. At the very least, here are basic things you should know about your health plan.
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