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Below are very brief injury and illness benefit highlights of the 2012-13 Premier Plan. Refer to the Description of Benefits for benefit details, specific exclusions, and limitations.
Plan Maximum:
- $300,000 of Covered Expenses per Injury or Sickness per Plan Year
Student Deductible:
- Not applicable under Schedule 1. (The Student Health Center and Counseling and Psychiatric Service are Schedule 1 Providers.)
- Students must pay the first $200 per Plan Year under Schedule 2 before the Plan pays for Medically Necessary Covered Expenses. (The UnitedHealthcare [UHC] Options PPO Network are Schedule 2 Providers.)
- Students must pay the first $250 per Plan Year under Schedule 3 before the Plan pays for Medically Necessary Covered Expenses. Any Deductible met under Schedule 2 is applied to the Schedule 3 Deductible. (Non-PPO Providers, including worldwide Providers, are Schedule 3 Providers.)
Co-Payment for Medically Necessary Office Visit Charges:
- $10 for a Medically Necessary Outpatient Primary Care or Mental Health Visit or $20 for a Medically Necessary Specialist Visit collected when the services are rendered.
Co-Insurance for Medical Care:
Co-insurance is the percent of Covered Expenses that the Plan will pay after applicable Deductibles and Co-payments. Insureds are responsible for the balance of remaining charges. The following represents typical co-insurance for the Premier Plan:
- Schedule 1, 100% of Student Health Center and Counseling and Psychiatric Covered Expenses.
- Schedule 2, 80% of Preferred Allowance of UHC PPO Option Network Provider's Covered Expenses.
- Schedule 3, 70% of other worldwide Provider's Covered Expenses.
Student Only Plan Out-of-Pocket Maximum:
- The Out-Of-Pocket maximum for Covered Medical and Mental Health Expenses is $5,000 per individual (not to exceed $10,000 for a family plan). Once a student has paid $5,000 of Covered Expenses in a Plan Year, the Plan pays 100%. Co-payments for prescriptions are not applied to the Out-Of-Pocket maximum.
Pharmacy Card (Medco):
- The pharmacy card accesses the Medco pharmacy network. The Co-payment is $10, $25, or $45. Co-payments are subject to change for any given prescription drug as bulk discounts change.
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