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home ̱б ̱б G ~ L
 
Georgia State University ̱бGeorgia State 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.

 

 

 

 

   Georgia State University   Ͽϴ.

 

 

 

 

Insurance  Provider

б޺

DBغ

 

 

 

Life Maximum

 

 

 

$500,000

Unlimited

benefits

 

Per Student: $100,000

 

Per Dependent: $50,000

 

 

$50,000 per Sickness or Injury

 

 

Deductible

 

δ

 

 

IN NETWORK:

 

$0

 

 

$0

 

 

OUT OF NETWORK:

 

$250

 

IN NETWORK

 

º̿

 

90%

100% ȸ翡

 

OUT OF NETWORK:

 

º̿

 

 

70%

100% ȸ翡

Maximum Out-of-Pocket

 

 

Ⱓδ

 

IN NETWORK:

 

student:  $10,000

 

Family:  $30,000

 

      δ

 

OUT OF NETWORK:

 

student:  $15,000

 

Family:  $45,000

 

 

 

 

 

Prescription Drug

 

ప δ

 

౹̿:

 

100% after $15 generic copayment / $30 brand name copay per 30-day supply per month

 

$1,000 maximum per

Policy Year

 

δ

Premium

(Annual)

 

Student:$1,050

Spouse:$3,266

Child:$1,646

 

 

Student:$480

Spouse:$480

Child:$480

 



 

 

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