Medical
Boone Health offers two medical options: Choice Plus and Choice. Both are administered by AmeriBen, allow access to the Anthem BCBS-MO Blue Access Choice Network of preferred providers, and cover the same medical services.
Similarities and differences:
- Both medical options include prescription drug coverage.
- In general, you will pay more out of your bi-weekly paycheck for Choice Plus, but pay considerably less in out-of-pocket costs for deductibles, copayments, and coinsurance for medical services.
- With the Choice option, you will pay less per pay period, but you will pay considerably more in out-of-pocket costs when you receive medical services.
There are four coverage levels within each medical option:
- Boone Health Network: You will save the most when you receive services from Boone Health facilities. Deductibles, coinsurance, and copayments are the lowest when you use the Boone Health Network.
- Health Cooperative of MO Network: Members of Boone’s medical plan may receive services from specific providers and facilities at a reduced out-of-pocket cost from Anthem In-network providers.
- Anthem BCBS-MO Blue Access Choice: The Anthem BCBS-MO Blue Access Choice Network features healthcare facilities and physicians who have agreed to provide services at a reduced cost.
- Out-of-Network: Services from healthcare providers not within the Boone Health Network, Health Cooperative of MO Network, or Anthem BCBS-MO Blue Access Choice Network may not be discounted.
CARE RECEIVED FROM A UNIVERSITY OF MISSOURI PROVIDER OR FACILITY WILL NOT BE COVERED UNDER THE MEDICAL PLAN. EXCEPTIONS WILL BE MADE FOR SERVICES THAT CANNOT BE PROVIDED BY BOONE HEALTH. CONTACT BOONEBENEFITS@BOONE.HEALTH OR CALL 573.815.3500 WITH ANY QUESTIONS.
Preventive care
Many preventive services are covered at no cost to you if received from a Boone Health Network, Health Cooperative of MO Network, or Anthem BCBS-MO Blue Choice Access provider.
ID Cards
AmeriBen will mail you two ID cards for plan year 2025. Members can access their digital ID card through engage.ameriben.com or the MyAmeriBen mobile app. If you do not have your ID card, your service provider or pharmacy can call AmeriBen to verify your eligibility based on your group number and your Social Security number.
Medical Coverage Chart
Boone Health Medical Plan members will incur NO out-of-pocket expenses (deductibles, coinsurance, or copayments) when receiving any outpatient lab work (e. g., blood draw) and/or outpatient radiology/imaging (including physician/ technician fees) at a Boone Health facility.
This chart provides examples of your payment responsibility under each medical option.
| Choice Plus | ||||
|---|---|---|---|---|
| Domestic | Health Cooperative of MO | In-Network | Out-of-Network | |
| Annual Deductible | ||||
| Per Individual | $600 | $900 | $2,000 | $4,000 |
| Per Family | $2,000 | $2,700 | $4,000 | $12,000 |
| Annual Out-of-Pocket Maximum | ||||
| Per Individual | $3,000 | $5,000 | $6,000 | Unlimited |
| Per Family | $6,000 | $10,000 | $12,000 | |
| Urgent Care | $50 | |||
| Emergency Room | $250 | |||
| Wellness and Preventive Care | $0 | $0 | $0 | Deductible, then 50% |
| Diagnostic/Non-Preventive Office Visit | ||||
| Primary Care Physician (PCP) | $20 | $20 | $30 | Deductible, then 50% |
| Specialists | $50 | $50 | $60 | Deductible, then 60% |
| Outpatient Short-Term Therapy | $0 | $50 | $50 | Deductible, then 60% |
| Chiropractic Care | N/A* | $25 | $25 | Not Covered |
| Outpatient Lab & Radiology (diagnostic) | $0 | Deductible, then 20% | Deductible, then 50% | Deductible, then 50% |
| Outpatient Surgery | Deductible, then 0% | Deductible, then 20% | Deductible, then 45% | $1,750 copay + deductible, then 50% |
| Hospital Services | ||||
| Inpatient Facility | Deductible, then 0% | Deductible, then 20% | Deductible, then 50% | $2,750 copay + deductible, then 60% |
| Outpatient Facility | Deductible, then 0% | Deductible, then 20% | Deductible, then 50% | Deductible, then 50% |
| Inpatient professional | N/A | Deductible, then 20% | Deductible, then 25% | Deductible, then 50% |
| Outpatient Professional | Deductible, then 0% | Deductible, then 20% | Deductible, then 25% | Deductible, then 50% |
| Choice | ||||
|---|---|---|---|---|
| Domestic | Health Cooperative of MO | In-Network | Out-of-Network | |
| Annual Deductible | ||||
| Per Individual | $1,000 | $2,000 | $3,000 | $6,000 |
| Per Family | $3,000 | $4,500 | $9,000 | $18,000 |
| Annual Out-of-Pocket Maximum | ||||
| Per Individual | $4,000 | $5,000 | $6,000 | Unlimited |
| Per Family | $9,200 | $10,000 | $12,000 | |
| Urgent Care | $60 | |||
| Emergency Room | $300 | |||
| Wellness and Preventive Care | $0 | $0 | $0 | Deductible, then 75% |
| Diagnostic/Non-Preventive Office Visit | ||||
| Primary Care Physician (PCP) | $25 | $25 | $40 | Deductible, then 75% |
| Specialists | $60 | $60 | $70 | Deductible, then 75% |
| Outpatient Short-Term Therapy | $0 | $50 | $50 | Deductible, then 80% |
| Chiropractic Care | N/A* | $25 | $25 | Not Covered |
| Outpatient Lab & Radiology (diagnostic) | $0 | Deductible, then 35% | Deductible, then 70% | Deductible, then 75% |
| Outpatient Surgery | Deductible, then 15% | Deductible, then 35% | Deductible, then 70% | $3,500 copay + deductible, then 75% |
| Hospital Services | ||||
| Inpatient Facility | Deductible, then 15% | Deductible, then 35% | Deductible, then 70% | $5,550 copay + deductible, then 75% |
| Outpatient Facility | Deductible, then 15% | Deductible, then 35% | Deductible, then 70% | Deductible, then 75% |
| Inpatient professional | N/A | Deductible, then 35% | Deductible, then 50% | Deductible, then 75% |
| Outpatient Professional | Deductible, then 15% | Deductible, then 35% | Deductible, then 50% | Deductible, then 75% |
* The Boone Health Facility Network does not include physicians.
** Billed by Facility. Technical charges for the tools and services that a professional use to provide health care services, such as equipment, supplies, operating room time, radiology, general nursing care, etc.
*** Billed by Physician. Professional charges for a physician or other licensed health care professional’s time and expertise to provide health care services to an individual.
Understanding Benefit Terms
Both medical options, Choice Plus and Choice, cover the same medical services, such as a visit to a primary care physician or specialist, a trip to the emergency room, or outpatient surgery. What is primarily different about the two options is the amount you pay for services, as well as the bi-weekly deductions from your paycheck (contributions), copayments, deductibles, and coinsurance.
Employee Costs for Medical Coverage
The costs below are pre-tax, per-pay-period deductions, based on 26 pay periods a year.
| Full-Time | Part-Time | |
|---|---|---|
| Choice Plus | ||
| Employee Only | $92.02 | $138.02 |
| Employee + Children | $154.75 | $232.13 |
| Employee + Spouse | $220.88 | $331.31 |
| Employee + Family | $283.41 | $425.12 |
| Choice | ||
| Employee Only | $46.04 | $69.06 |
| Employee + Children | $84.03 | $126.05 |
| Employee + Spouse | $122.73 | $184.09 |
| Employee + Family | $161.44 | $242.16 |