UF Trail Blazer Elite

 

  • Meets 2019-2020 Insurance Requirements for UF Students and Scholars
    Rates Starting at $82 per month
    $600,000 Medical Maximum per Accident or Sickness
    No Copay at Student Health Center
    Physicals and Immunizations

Rates (per month)

$82

Benefits

Coverage

Annual/Lifetime Maximum

Unlimited

Maximum per Covered Accident or Sickness

$600,000

Treatment Period

First Charges must occur within 30 days after the date of the Covered Accident or Sickness

Deductible

$500 per Policy Period

In Network Coinsurance

Single:  80% of Preferred Allowance up to $50,000; 100% of Preferred Provider Charges thereafter

 
Family:  80% of Preferred Allowance up to $75,000; 100% of Preferred Provider Charges thereafter

Out of Network Coinsurance

60% of Usual and Customary

Maximum Out of Pocket (In Network Only)

$10,000 Single/ $15,000 Family                                      Max out of Pocket Excludes Copays/Deductibles and Non Covered Charges

Physicals and Immunizations

Covered at 100% to a maximum of $500

In Network and at Student Health Center Only 

Copays/Deductible per Visit:

 

Dr's Office Visit

$25 (Waived at Student Health Center)

Emergency Room

$0

Hospital room and Board

$0

MRI/CAT Scans

$0

Prescription Drugs

$20 Generic

$10 Oral Contraceptives   

$40 All Other                     

(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

Not Applicable

Pregnancy

Covered as any other condition. 

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

$2,500 Injury Only

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

$2,500

 

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.