|
Sickness/Injury |
Supplemental |
| Cost |
Student - $1,620
Spouse - $1,897
Child - $1,083 |
$266 |
| Benefit per Sickness |
85% In Network
50% Out of Network
$100 deductible
Maximum Benefit per Sickness:
$100,000 |
85% In Network
50% Out of Network
$100 Deductible
Maximum Benefit per Sickness:
$100,000 |
| Lifetime Maximum Benefit |
N/A |
Benefit: $250,000 |
| Physician Visits Copayment |
$10 In Network
$20 Out of Network |
Same |
| Prescription Drugs Copayment |
$5 Generic
$10 Name Brand
(if filled at a Medco participating pharmacy)
Per year Maximum: $1,250 |
Same |
