Insurance  Provider

학교제휴보험

Life Maximum

$200,000

Unlimited

Major Benefit

$200,000

$100,000 per Sickness or Injury

DESCRIPTION OF BENEFITS

BASIC ACCIDENT & SICKNESS

EXPENSE BENEFITS

보험회사에서

보상하는비율

1. 100% of Eligible Expenses up to the first $1,000 then

2. 80% of Eligible Expenses up to $5,000 then

3. 100% of the remaining Eligible Expenses up to a combined maximum of $75,000 per covered

Accident or Sickness for the Eligible Expenses shown below.

Some benefits have limitations other than stated

above.

*Benefits for treatment of Injuries arising from

participation in interscholastic sports are limited

to $1,000 per Injury.

$100,000에서

보험 회사에서100%보상

Deductible

고객부담금

$50

No deductible

Drugs

약값부담금

$25 for formulary brand name drugs

or $40 for non-formulary brand name drugs,

the cost of prescription drugs is payable in

full to a Policy Year maximum of $1,500

총 보상 한도에서 보상

고객 부담금 $0

Premium

(Annual)

Student:$1,089

Student:약$480

Spouse:약$480

Child:약$480