UF Scholar Trail Blazer 

 

  • Rates Starting at $52 per month
    $300,000 Medical Maximum per Accident or Sickness
    $100 Deductible per Accident or Sickness
    $25 Office Copay (Waived at Student Health Center)

Rates (per month)

$52
Benefits Coverage
Annual/Lifetime Maximum Unlimited
Maximum per Covered Accident or Sickness $300,000
Treatment Period First Charges must occur within 30 days after the date of the Covered Accident or Sickness
Deductible $100 per accident or sickness (Reduced to $50 for treatment at Student Health Center)
In Network Coinsurance 80% of Preferred Allowance Charges
Out of Network Coinsurance 70% of Usual & Customary Charges
Copays/Deductible per Visit:  
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                         

(per prescription)

Benefit Period From the date of the Covered Accident or Sickness to the Policy Termination Date
Extension of Benefits 3 Months if Hospitalized for a Covered Accident or Sickness at time of Coverage Expiration Date.
Pre-Existing Condition Limitation 6 months (Prior creditable coverage under an ISP Policy)*
Pregnancy Not Covered

Maximum for Dental Treatment (made necessary by Injury to Sound, Natural teeth only)

$2,500 Injury Only
Max. for Physiotherapy (Outpatient) 40 Visits
Max. for Psychotherapy (Inpatient) 40 Days
Max. for Psychotherapy (Outpatient) 40 Visits
Max. for Braces & Appliances $5,000
Emergency Evacuation/Repatriation of Remains 100% of Actual Cost
Accidental Death and Dismemberment    Principal Sum $10,000
Emergency Reunion $3,500

*This Coverage contains a Pre-Existing condition limitation.  Out of Country Medical Maximum benefit of $50,000 may be applicable 

 This is a brief summary of the ISP plan contained within and is not a contract of insurance. The terms and conditions of coverage are set forth in the Plan issued to the Participating Organization. If any conflict should arise between this summary and the respective Plan, the terms of the Plan will govern in all cases.