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Vanderbilt University ̱бVanderbilt University
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.

 

    

 

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



 

 

 

 

 

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