Insurance  Provider

학교보험제휴

LIG손해보험

Lifetime Maximum

$50,000

Unlimited

Benefit

$50,000 

$50,000 per Sickness or Injury

 협력병원이용시/

보험회사부담비율

IN-NETWORK: 80%

100%

비협력병원/

보험회사부담비율

OUT-OF NETWORK:80%

  DEDUCTIBLES /

CO-PAYMENTS

고객부담금

Physician’s Office Visit:

$15 co-pay per visit until the overall

$50 deductible maximum has been met.

• Emergency Room Visit: $50 co-pay per visit.

• STD Testing: $20 co-pay.

• All Other Lab Work:

$15 co-pay

Prescription Drug

(약값고객부담금)

After a Co-pay of $15 for generic or $35 for

a brand name drug (per 30-day supply of a prescription or refill),

the cost of prescription drugs is payable in full up to a maximum

of $1,000 for the Policy Year

보상한도에 포함

고객부담 없음

Premium

(Annual)

Student: $1,288

Student: $492

Spouse: $492

Child: $492