Insurance  Provider

학교제휴보험

Life Maximum

$200,000

Unlimited

Major Benefit

$200,000

$50,000 per Sickness or Injury

Copayment

보험회사에서

보상하는비율

       In Network: 80%

100%

      Out of Network: 64%

100%

OUT-OF-POCKET

MAXIMUMS

년간 고객부담금

       In Network :$5,000

$0

      Out of Network:  No Limit.

Deductible

고객부담금

In Network: $250

No deductible

Out of Network: $500

Prescription Drug

약값고객 부담금

In Network:

Following a $40 Copay for each brand name prescription drug or a $15 Copay

maximum of $1,000 per Policy Year

총 한도내에서 보상함

고객 부담금 없음

Out of Network:

Following a $40 Deductible for each brand name

prescription or a $15 Deductible

maximum of $1,000

per Policy Year

Premium

(Annual)

34 years and under

Student:$1,414

Spouse:$3,869

Child:$2,591

Student:약$480

Spouse:약$480

Child:약$480