If you have ever looked at your medical ID card and wondered, “Who exactly is my insurance company?” you are not alone.

Missouri State’s medical plan is self-funded, meaning the University—not an insurance company—is responsible for paying covered claims. The University contracts with Point•C as its third-party administrator (TPA) and has a direct contract with Mercy for the primary PPO network.

For care outside the primary Mercy network, the plan uses additional PPO networks, commonly called wrap networks.

Understanding the Terms

Self-funded plan: Missouri State funds the payment of covered claims and assumes the financial risk.

Point•C: Point•C is the University’s TPA. It administers the plan, processes claims, provides customer service and coordinates the network arrangements.

Mercy: Missouri State has a direct contract with Mercy for the primary PPO network.

Wrap networks: These provide access to participating providers outside the primary Mercy service area. The University’s wrap networks include: FirstHealth, HealthLink,Freedom Network Select

This distinction can be confusing because a provider may recognize a wrap network, such as FirstHealth, but not recognize Point•C.

What Should I Tell My Provider?

When providing insurance information, always show the provider your Point•C medical ID card and have them use the information on the card to verify your coverage and network.

Don’t simply tell a provider, “My insurance is Point•C.” Point•C is the TPA, and the provider may not recognize that name in its system.

Instead, ask the provider to verify participation in the appropriate PPO network shown on your card.

For example, FirstHealth is a PPO network partner. It also has other business operations, including insurance products, which can add to the confusion. A provider participating in the FirstHealth PPO network should not submit your Missouri State claim directly to FirstHealth as your insurance company. The claim should be submitted using the information on your Point•C ID card.

Point•C then routes the claim through the appropriate network, where the claim may be repriced (discounted) based on the provider’s contracted rates before being processed under the University’s health plan.

Care Outside Southwest Missouri

When receiving care outside the primary Mercy Southwest Missouri network, the wrap-network provisions become important.

Authorization may be required for services outside Southwest Missouri—even when the provider is a Mercy provider. Being somewhere else in Missouri does not automatically mean you can use a Mercy or wrap-network provider without authorization.

There are also specific authorization requirements for Mercy tertiary network providers outside Southwest Missouri. Do not assume that because a provider is part of the Mercy system, services outside Southwest Missouri automatically receive the same network coverage as services provided through the primary local Mercy area.

Employees who live outside the Southwest Missouri network area may use the University’s wrap networks to access PPO-level benefits, subject to the plan’s applicable provisions.

Wrap Networks and Travel

The University’s wrap networks also provide access to participating providers when you are traveling outside Missouri. Before receiving non-emergency care while traveling, verify that the provider participates in the appropriate wrap network and determine whether authorization is required.

Current wrap networks include:

• FirstHealth: 800-226-5116, firsthealth.com
• HealthLink: 800-624-5356, healthlink.com
• Freedom Network Select: phpkc.com

For emergency care, seek treatment immediately rather than delaying care to determine network participation.

The Bottom Line

Think of the plan this way:

Missouri State University → Funds the self-funded medical plan.

Point•C → Administers the plan and processes claims.

Mercy → Direct PPO network for Southwest Missouri.

Wrap networks → FirstHealth, HealthLink and Freedom Network Select provide additional network access outside the primary Mercy service area.

Providers → Provide your care and submit claims using the information on your Point•C medical ID card.

The terminology can be confusing because provider offices do not always understand or  distinguish these differences. However, having a general understanding of these differences can help prevent billing problems.

This is general information. The official medical plan document is governing policy.

Need Help Finding In-Network Care?

Not sure where to start when looking for an in-network provider? See our related blog, Finding In-Network Care: Using Your Campus Resources and the Mercy PPO Provider Directory, for tips on using Magers Health and Wellness Center and the Mercy PPO provider directory to find appropriate in-network care.

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