Insurance  Provider

학교제휴보험

Life Maximum

$100,000

Unlimited

Benefits

$100,000

$100,000

per Sickness or Injury

Deductible

고객부담금

Preferred Care:

$150 per Policy Year

$0

Non-Preferred Care:

$500 per Policy Year

Preferred :

협력병원이용시

90% of the Negotiated Charge

100% 보험 회사에서 보상

Non-Preferred:

비협력병원이용시

70% of the Negotiated Charge

OUT OF POCKET MAXIMUMS

년간 고객 부담금

Preferred Care:

Out-of-Pocket: $10,000

고객 부담금 없음

Non-Preferred Care:

Out-of-Pocket: $20,000

Prescription Drug

약값 부담금

협력약국시:

Preferred Care

100% of the Negotiated Charge after the applicable per prescription

Copay:

Generic Prescription Drug:

$10 Copay/Deductible

Brand Name Prescription Drug: $20 Copay/Deductible

Non-Formulary Brand name: $35 Copay/Deductible

up to $1,500 per Policy Year.

고객 부담금 없음

비협력약국시:

Non-Preferred Care

50% of the Reasonable Charge after the applicable per

prescription Deductible

Generic Prescription Drug:

$10 Copay/Deductible

Brand Name Prescription Drug: $20 Copay/Deductible

Non-Formulary Brand name: $35 Copay/Deductible

up to $1,500 per Policy Year.

Premium

(Annual)

Student:$1,239

Spouse:$3,958

Child:$1,118

Student:약$480

Spouse:약$480

Child:약$480