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home ⺸ Խû
 
University of San Francisco ̱бUniversity of San Francisco
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 San Francisco Ͽϴ.

 

 

 

 

Insurance  Provider

 

б޺

DBغ

 

 

Life Maximum

 

 

$100,000

Unlimited

 

 

Benefits

 

 

 

$100,000

 

$100,000

per Sickness or Injury

 

 

Deductible

 

δ

 

Preferred Care:

 

$150 per Policy Year

 

 

$0

 

Non-Preferred Care:

 

$500 per Policy Year

 

 

Preferred :

 

º̿

 

 

90% of the Negotiated Charge

100% ȸ翡

 

Non-Preferred:

 

º̿

 

70% of the Negotiated Charge

 

OUT OF POCKET MAXIMUMS

 

 

Ⱓ δ

 

Preferred Care:

 

Out-of-Pocket: $10,000

 

δ

 

Non-Preferred Care:

 

Out-of-Pocket: $20,000

 

Prescription Drug

 

ప δ

 

¾౹:

 

Preferred Care

 

100% of the Negotiated Charge after the applicable per prescription

Copay:

 

Generic Prescription Drug:

$10 Copay/Deductible

Brand Name Prescription Drug: $20 Copay/Deductible

Non-Formulary Brand name: $35 Copay/Deductible

 

up to $1,500 per Policy Year.

 

δ

 

¾౹:

 

Non-Preferred Care

 

50% of the Reasonable Charge after the applicable per

prescription Deductible

Generic Prescription Drug:

$10 Copay/Deductible

Brand Name Prescription Drug: $20 Copay/Deductible

Non-Formulary Brand name: $35 Copay/Deductible

 

up to $1,500 per Policy Year.

 

 

Premium

(Annual)

 

 

Student:$1,239

Spouse:$3,958

Child:$1,118

 

Student:$480

Spouse:$480

Child:$480

 



 

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