Ȩ Ұ ̱б ⺸谡Խû ܱ⺸谡Խû û
 
 
 
 
 



home ⺸ Խû
 
University of Colorado at Boulder ̱бUniversity of Colorado at Boulder
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 Colorado at Boulder   ǥԴϴ.

 

 

Insurance  Provider

б޺

DBغ

 

 

Aggregate Maximum

 

 

 

 

$500,000

 

 

 

Unlimited

 

 

 

Major Benefit

 

 

$500,000

$50,000 per Sickness or Injury

Out-of-Pocket Maximum

 

(δ)

 

$5,000 in network

 

$0

 

$10,000 out of network

 

 

 º̿/

 

ȸ

 

In Network : 80%

100%

 

                   º /

 

            ȸ

 

Out of  Network:50%

100%

Deductible

 

(δ)

$200

$0

Prescription Drug

 

(δ)

 

$7,500 maximum per policy year

United Healthcare Network Pharmacy

(UHPS)/ $50 deductible per policy year

 

$15 copay per prescription for Tier 1

$30 copay per prescription for Tier 2

$60 copay per prescription for Tier 3

up to a 31-day supply per prescription

 

׺

Premium

(Annual)

 

Student:$1,115

Spouse:$2,295

Per Dependent :$1,380

 

 

Student:$480

Spouse:$480

Child:$480

 



 

 

 

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