Insurance  Provider

 학교제휴보험

Accident Death & Disability, Accident Medical Expenses, and Sickness Medical Expenses total to less than $250,000

Accident Death & Disability, Accident Medical Expenses, and Sickness Medical Expenses total to less than

$250,000

고객 부담금

Medical Calendar Year Deductible (Individual/Family)

None

Medical Calendar Year Deductible (Individual/Family)

None

년간 고객 부담금

Annual Out-of-Pocket Maximum

$3,000/$6,000

Annual Out-of-Pocket Maximum

$0

Outpatient  

care

외래 환자 

고객부담금

Office visits: $20 copay

$0

Maternity/Prenatal Care^2:

$15 copay

보상안함

Vaccines (immunizations):

No charge: $5 copay

보상안함

Allergy injections: $20 copay

보상 가능함 $0 copay

 (기왕증은 보상안됨)

MRI, CT and PET: $50 copay

$0

Outpatient surgery:

$250 copay per procedure

$0

응급실고객부담금

Emergency department visits (waived if admitted directly to hospital): $150 copay

$0

Ambulance services:

$150 copay

$0

Generic MOI (up to a 100-day supply): $20 copay

$0

Prescriptions

처방고객부담금

Brand (up to a 30-day supply):

$30 copay

$0

Brand MOI (up to a 100-day supply):

$60 copay

Student : $1,620

 Student and Spouse:

$3,566

 Student and Child(ren):$3,241

학생:  약$480

배우자:약$480

자녀:  약$480