University of Wisconsin.Madison  | 
	  ̱б University of Wisconsin.Madison | 
	 
	
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		 Ȩ л, ȯ, ýĮ, Ʈ,   ⱹϽô ݰ е  ϽǼ ִ Դϴ.  Ͻø û ۼ ֽðų ̸ ֽø ˴ϴ. ǽð  Ͻø MSN ȭ ߰ ֽø ܱ ô    Ǹ ϽǼ ֽϴ. | 
		 
 
  
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 Insurance  Provider  | 
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 DBغ 
 
 
 
 
 
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Life Maximum 
  
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 $1,000,000  | 
 Unlimited  |  
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benefits 
  
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 $1,000,000  | 
   
$50,000 per Sickness or Injury  |  
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 OUT-OF-POCKET LIMIT AMOUNT 
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Ⱓδ 
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 In-Network :$2,000 
  
Out-Of-Network:$4,000  | 
  δ   |  
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In‐Network 
º̿ 
ȸ纸 
  
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90%  | 
   
100% ȸ翡  |  
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Out-of-Network 
  
º̿ 
ȸ纸 
   | 
 60%  | 
 100% ȸ翡  |  
| 
   
δ  | 
   
in-Network: 
  
$250 per policy year 
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δݾ  |  
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Out-Of-Network: 
  
$500 per policy year 
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Prescription Drug 
  
పδ  | 
 $10~$25 copay  | 
 Ѻѵ 
δݾ  |  
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Premium 
(Annual) 
  
  
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   Ʒ   
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  Spouse: $480 
Child: $480  |   
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ʴ¼ 
    1. (谡ִȯ̳üġװ˻縦ιѺ)    2. ӽ, õȺ   3. ܼ ǰ ˻縦  ϴ (÷°˻װǰ)    4 . (бнImmunization )  
5. Ű ȯ/ൿ 
6. HIV() 
7. (ΰἮ) 
8. ȯN39 ǴDZ 
  
  
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