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 |