Insurance Provider
|
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LIG¼ÕÇØº¸Çè |
Lifetime Maximum
|
$100,000 |
Unlimited |
Benefit
|
$100,000 |
$50,000 per Sickness
or Injury |
Deductible
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Preferred Care:
$350 per Covered Person, per Policy Year
|
$0 |
Non-Preferred Care:
$500 per Covered Person, per Policy Year.
|
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|
Preferred Care:
80%
|
100% |
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Non-Preferred Care:
50%
|
OUT OF POCKET
MAXIMUMS
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Preferred Care:
$3,000 per Covered Person
|
$0 |
Non-Preferred Care:
$6,000 per Covered Person
|
Prescription Drugs Expense
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|
Preferred Care:
100% of Negotiated
Rate following a
$20 Copay for each
30-day
|
$0 |
Non-Preferred Care: 100% of Reasonable Charge, (which may be less than the billed
charge) following a
$30 Copay for each
30-day
|
Premium
(Annual)
|
Student: $1,134
Spouse: $3,464
Children: $1,739
|
Student: $492
Spouse: $492
Child: $492 |