Indiana University of Pennsylvania б .
Insurance Provider |
б
|
DBغ |
Life Maximum
|
$50,000
|
Unlimited
|
Major Benefit
|
$50,000 |
$50,000 per Sickness or Injury |
Copayment
ȸ翡 ġ
ϴº |
In Network:
80% up to $2,500
|
ȸ翡100% |
Out of Network:
60% of Reasonable &
Customary Charges up to
$2,500
|
ȸ翡100% |
2010-2011 SUMMARY OF BASIC INSURANCE BENEFITS
FOR EACH INJURY OR SICKNESS COVERAGE IS PROVIDED UP TO $2,500 BASIC BENEFIT AS SPECIFIED BELOW. MAJOR MEDICAL BENEFITS ARE PROVIDED UP TO $50,000 FOR COVERED INJURY & SICKNESS AS SPECIFIED BELOW. This Policy provides benefits for the Reasonable and Customary Charges incurred by a Covered Person for loss due to a covered Injury or Sickness up to the Maximum benefit of $50,000. Benefits will be paid up to the Maximum Benefit for each service as specified in the following schedule. Injury Expenses are paid to Plan Maximum; 80% Preferred Provider, $500 OOP Max, 60% Non-Preferred Providers, $500 OOP Max Collegiate Sports Injuries covered to a $2,500 Maximum, Club Sports Injuries covered to a $1,000 Maximum.
|