Rates (per month)
| Benefits | Coverage |
|---|---|
| Annual/Lifetime Maximum | Unlimited |
| Maximum per Covered Accident or Sickness | $300,000 |
| Deductible | $100 per accident or sickness (Reduced to $50 for treatment at SHC) |
| In Network Coinsurance | 80% of Preferred Provider Charges |
| Out of Network Coinsurance | 70% of Usual & Customary Charged |
| Pre-ex | 6 months |
| Copays: | |
| Dr's Office Visit | $25 (Waived at Student Health Center) |
| Emergency Room | $200 |
| Hospital room and Board | $200 |
| 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 |
| Family Reunion | $3,500 |
| Emergency Reunion | $3,500 |
