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Rhode Island School of Design ̱бRhode Island School of Design
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.

 

 

 

Rhode Island School of Design

 

 

SCHEDULE OF MEDICAL EXPENSE BENEFITS

 

BASIC MEDICAL EXPENSE BENEFIT: Basic Medical Expense Benefits will be paid up to the maximum benefit for each service as scheduled

below up to a maximum benefit of $5,000 per Covered Accident or Sickness. The combined Maximum Benefit for the Basic Maximum Benefit

and the Major Medical Expense Benefit is $50,000 per Covered Accident or Sickness.

 

MAJOR MEDICAL EXPENSE BENEFIT: After the Company has paid $5,000 per covered Accident and Sickness under the Basic Medical Expense

Benefit , the Company will pay 80% of the Preferred Allowance for Network Providers or 80% of Usual, Reasonable and Customary Charge for

Non-Network Providers for additional Covered Expenses incurred up to $25,000 per Accident and Sickness (unless otherwise specified). After the

Company has paid $25,000, the Company will pay 100% of the Preferred Allowance for Network Providers or 80% of Usual, Reasonable and

Customary Charge for Non-Network Providers additional Covered Expenses up to $50,000 per Accident and Sickness (unless otherwise specified).

The total benefit payable under Major Medical coverage for any one covered Accident or Sickness is $50,000 minus all amounts paid under the

Basic Medical Expense Schedule of Benefits. In addition to the exclusions, benefits under the Major Medical benefit are not payable for Outpatient

Physical Therapy, Mental or Nervous Disorder or Alcohol and Drug Abuse, except as otherwise indicated.

 

 

 

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Insurance  Provider

 

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Life Maximum

 

 

$50,000

Unlimited

 

 

Major Benefit

 

 

$50,000

 

$50,000 per Sickness or Injury

 

 

 

Copayment

 

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In Network: 100%

100%

 

Out of Network: 80%

 

Prescription Drug

 

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Subject to a $10 co-payment for a 30-day supply of a generic

drug and a $20 co-payment for a 30-day for a brand name

drug up to a maximum benefit of $1,500 per policy year.

 

$0

 

Premium

(Annual)

 

 

Student:$838

Spouse:$2,568

Child:$1,071

 

 

Student:$480

Spouse:$480

Child:$480

 



 

 

 

 

 

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