In-Network Coverage Summary 2019-20 Plan Year
|Preventative||100% covered (you pay $0)|
|Primary Care||$15 co-pay for office visits|
|Physical Therapy||$15 co-pay for office visits|
|Specialists||$25 co-pay for office visits|
|Urgent Care||$35 co-pay for office, $50 outside UHS|
|Counseling||No co-pay for short-term counseling from UHS, $15 co-pay outside of UHS|
|Emergency Room||$250 co-pay (waived if admitted; deductible waived)|
|Hospitalization||$250 co-pay per admission then 90% coverage (you pay 10%) *subject to deductible|
|Labs/Tests/X-rays||90% coverage (you pay 10%) *subject to deductible outside UHS|
|Prescription Drugs||Inside Tang:
|Dental||100% coverage for exams and cleanings twice per year, 80% coverage for basic services, and 70% coverage for major services (up to $2,000 benefit maximum per year). $25 deductible applies to basic and major services.|
|Vision||$10 co-pay for eye exam, $25 co-pay for frames and lenses (up to $150/year) or contact lenses (up to $150/year)|
|Deductible||*$300 for some medical services outside of the Tang Center|
- Coverage periods:
- Fall 2019: August 1, 2019 - December 31, 2019
- Spring 2020: January 1, 2020 - July 31, 2020
- All medical and mental health care, with the exception of emergency room or urgent care serivces, must begin at University Health Services (UHS). All non-emergency services outside of UHS must be approved by the Student Health Insurance Office in order to ensure payment for services.
- There is a $300 per plan year deductible for some medical services provided outside of UHS.
- If providers or facilities are used that are not part of in-network provider, claims will be paid at 50% of the non-network rate (customary and reasonable), which is often significantly lower than the in-network rate. For example, 90% coverage of the in-network rate is going to be less costly to the patient than 50% coverage of the non-network rate.