Vanderbilt University 䱸
1.I am currently enrolled in one of the above stated health insurance plans that will remain in effect August 12, 2011 – August 11, 2012.
2.My current insurance plan provides coverage for at least $100,000 per injury or sickness.
3.My current insurance plan pays for medical expenses at 80% of reasonable and customary charges.
4.My current insurance plan provides unlimited benefits for medical evacuation and repatriation of remains.
5.My current insurance plan provides coverage for the following services in the Vanderbilt University area: Doctors, specialists, hospitals and other health care providers Inpatient and outpatient hospitalization Inpatient and outpatient counseling and mental health services Lab work, diagnostic x-rays, physical therapy and chiropractic care Emergency room treatment and ambulance services Maternity care Prescription drugs I am granting Vanderbilt University permission to verify this information. If it is determined that the information provided on this form is invalid, I understand that I will be enrolled into and billed for the Student Health Injury and Sickness Insurance Plan for that term and for future, subsequent terms.
INSURANCE WAIVER Ʈ
https://www.gallagherkoster.com/students/user-login.php?idField=1015
Vanderbilt University ǥԴϴ.
Insurance Provider
|
б |
DBغ |
Lifetime Maximum
|
$100,000 |
Unlimited |
Benefit
|
$100,000 |
$100,000 per Sickness or Injury |
Deductible
δ |
Student: $200
Family: $400
|
$0 |
In Network
º̿/ȸδ
|
In Network : 85% |
100% |
Out of Network
º/ȸδ
|
Out of Network:65% |
VU Medical Center
ȸδ
|
90% |
ºƮũ
|
UnitedHealthcare |
UnitedHealthcare |
Prescription Drug
ప δ
|
$10.$25.$45 . 30 ѵ̸ ѵ$1,000 |
ѵ
δ |
Premium
(Annual)
|
Student::$2,142
Spouse:$2,692
Child:$1,691 |
Student:$870
Spouse:$480
Child:$480 |
|