Trail Blazer Basic

 

  • $500,000 Medical Maximum Per Accident or Sickness
    Unlimited Lifetime Maximum
    $200 Deductible per Policy Period

Rates (per month)

$90
BenefitsCoverage
Annual/Lifetime Maximum Unlimited
Maximum per Covered Accident or Sickness $500,000
Deductible $200 per Policy Period
Coinsurance Single:  80% of Covered Expenses for the first $15,000; 100% of Covered Expenses thereafter                                                           Family:  80% of Covered Expenses for the first $35,000; 100% of Covered Expenses thereafter
Maximum Out of Pocket $3,000 Single/ $7,000 Family
Pre-Existing Condition Limitation 6 months
Copays:  
Dr's Office Visit $25 Waived at Student Health Center
Emergency Room $150
Hospital room and Board $150
Prescription Drugs $25 Generic $50 All Other
Maximum for Dental Treatment $2,500 (Injury Only)
AD&D $10,000
Emergency Evacuation/Repatriation of Remains 100% of Actual Cost
Emergency Reunion $2,500
Family Reunion $2,500