Medical Coverage
University Health Services: No Charge for University Health Services office visit.
Primary Care or Specialist Office Visit: $20 Copayment* due at the time of service, 80% of remaining
balance is paid for by The Plan, 20% of remaining balance is the responsibility of the student.
* Copayments do not accumulate toward the out-of-pocket maximums.
Urgent Care Facility: $30 Copayment* due at the time of service, 80% of remaining balance is paid for by the Plan, 20% of remaining balance is the responsibility of the student.
* Copayments do not accumulate toward the out-of-pocket maximums.
Emergency Room: $50 Copayment* due at the time of service (waived if admitted), 80% of remaining
balance is paid for by the Plan, 20% of remaining balance is the responsibility of the student.
* Copayments do not accumulate toward the out-of-pocket maximums.
Outpatient Services
In-Network: 80% of eligible charges are paid for by the Plan, the remaining 20% of charges are the
responsibility of the student.
Out-of-Network:
60% of eligible charges are paid for by the Plan, the remaining 40% of charges are the
responsibility of the student.
* This includes outpatient maternity services.
Mammography
The Plan will pay the cost, up to $85 per exam, for routine mammograms as follows:
| Student Age (Years) | # Exams |
| 35 but less than 40 | 1 every 4 plan years |
| 40 but less than 50 | 1 every 2 plan years |
| (1 per plan year if certified as high risk for breast cancer) |
| over 50 | 1 per plan year |
Inpatient Services*
In-Network: 80% of eligible charges are paid for by the Plan; the remaining 20% of charges are the
responsibility of the student.
Out-of-Network: 60% of eligible charges are paid for by the Plan; the remaining 40% of charges are the
responsibility of the student.
*This includes inpatient maternity services
Medical Plan Out of Pocket Maximums:
In-Network: $5,000, per Plan Year
Out-of-Network: $7,500, per Plan Year
The Plan will pay 100% of the excess of eligible expenses incurred after the out-of-pocket maximum has been met, up to a maximum benefit of $250,000 per Plan Year.
Student Medical Plan Year and Lifetime Maximums:
Medical and Prescription Benefits Plan Year Maximum: $250,000
Medical and Prescription Benefits Lifetime Maximum: $2,000,000