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home ̱б ̱б G ~ L
 
Indiana University Bloomington ̱бIndiana University Bloomington
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 Bloomington б .

 

 

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

 



 

 

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