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Indiana University ̱бIndiana University
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.

 


 

   Indiana University  б  DB .

 

 

Insurance  Provider

 

б޺

DBغ

 

 

Life Maximum

 

 

$100,000

Unlimited

 

 

 

Major Benefit

 

 

 

$100,000

 

 

$50,000 per Sickness or Injury

Copayment

 

ȸ翡

 

ϴº

 

 

In Network: 100%

 

 

100%

 

 

Out of Network: 50%

 

 

 

Deductible

 

δ

 

In Network :

 

$500 Per Covered Person Per Policy Year.

 

No deductible

 

Out of Network:

 

$750 Per Covered Person Per Policy Year

 

 

OUT-OF-POCKET

 

MAXIMUMS

 

δ

 

Individual $1,000

$0 

 

 

 

 

Prescription Drug

 

 

పδ

 

In Network  :

 

100% of the Negotiated Charge, following a $20 copay for each Brand

Name Prescription Drug or

a $10 copay for each Generic Prescription Drug.

 

 

$0 

 

Out of Network :

 

Not applicable.

 

 

$0 

 

Premium

(Annual)

 

 

Student:$892

Spouse:$2,133

Children:$1,619

 

 

Student:$480

Spouse:$480

Child:$480

 

 

 

 

 

 



 

 

 

Requesting a Waiver

 

If you already have other health insurance coverage you may apply for a waiver from the mandatory plan. Not all insurance plans will qualify you for a waiver.

The minimum coverage requirements for waiver approval are as follows:

  • $50,000 coverage for each sickness
  • $50,000 coverage for each injury
  • $10,000 medical evacuation to home country
  • $7,500 repatriation of remains to home country
  • Deductible (or excess fee) not more than $500 per sickness or injury (per person)
  • $100,000 lifetime policy maximum
  • Maternity Benefits (female students only)

To qualify for a waiver, students must have qualifying insurance for the entire coverage period. Students applying for Fall waivers, must have coverage for at least August 15th through December 31st. Students applying for Spring/Summer waivers, must have coverage for at least January 1st though August 14th.

All waivers are submitted through the iStart system. Regardless of the length of your insurance coverage, a new waiver must be submitted each semester.

The waiver deadline is always 10 days after the start of classes each semester. The electronic waiver form becomes available 30 days prior to the start of the semester


 

 

 

 

 

 

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