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University of Notre Dame ̱бUniversity of Notre Dame
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.

 

  

 

      University of Notre Dameб .

 

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: 80%

 

 

100%

 

 

Out of Network: 60%

 

 

 

 

Deductible

 

δ

 

$200 per Covered Person

per Policy Year

No deductible

 

Annual

Out-of-Pocket

Limit

 

δ

 

$2,500

$0

 

 

 

 

 

 

Prescription Drug Benefits

 

పδ

 

 

At University HealthServices (UHS):

 

100% of the cost after $5 copay Generic Drugs/ $25 copay for Brand-Name drugs

and $35 copay

 

 

 

$0

 

Non-UHS Pharmacy:

 

After Deductible is met,80%

 for Generic Drugs 60% Brand-Name Drugs

 

 

 

Premium

(Annual)

 

 

Student:$1,239

Spouse:$3,098

Child:$1,859

 

Student:$480

Spouse:$480

Child:$480



 

 

 

 

 

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