Trail Blazer Basic

 

  • Rates Starting at $50 per month
    $500,000 Medical Maximum per Accident or Sickness
    $150 Deductible per Policy Period
    $25 Office Copay (Waived at Student Health Center)

Rates (per month)

$50
Benefits Coverage
Annual/Lifetime Maximum Unlimited
Maximum per Covered Accident or Sickness $500,000
Deductible $150 per Policy Period
In Network Coinsurance Single:  80% of Preferred Provider Charges up to $15,000; 100% of Preferred Provider Charges thereafter 
Family:  80% of Preferred Provider Charges up to $35,000; 100% of Preferred Provider Charges thereafter
Out of Network Coinsurance 70% of Usual & Customary
Maximum Out of Pocket- In Network Only $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 $75
Hospital room and Board $75
MRI/CAT Scans $100
Prescription Drugs $25 Generic $50 All Other $15 Oral Contraceptives
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

 Florida Trail Blazer Brochure