BGSUs 2013-2014 Student Health Insurance Policy

UnitedHealthcare Student Resources

Compare cost and benefits
$665.00 Fall Semester 8/1/2013 12/31/2013 $916.00 Spring Semester 1/1/2014-7/31/2014 OR $1,581.00 Annual Coverage 8/1/2013 7/31/2014

Plan Cost for 2013-2014 Policy $500,000 Maximum Annual Deductible Annual out-of-pocket

Per illness/injury per policy year $175 per illness/injury, maximum of two $350 maximum deductible per policy year $5,000 (Per Insured Person) (Per Policy Year)
Deductibles and Co-pays do not apply towards meeting the out of pocket maximum.

Expenses

Preferred Provider

Non-Preferred

Physician Office Visit

75% of the Negotiated Charge $20 per visit co-pay Deductible Does Not Apply

50% of the Reasonable Charge $40 per visit deductible

Inpatient Hospitalization Emergency Room (per visit co-pay/per visit deductible waived if admitted) X-ray and Lab Prescription Drug

75% of the Negotiated Charge after a $250 per visit co-pay

50% of the Reasonable Charge after a $250 per visit deductible

80% of the Negotiated Charge after a $100 per visit co-pay 75% of the Negotiated Charge $20 per visit co-pay Deductible Does Not Apply 80% of Negotiated Charge if filled at any UHC Preferred Pharmacy Deductible Does Not Apply 75% of the negotiated charge $20 per visit co-pay Deductible Does Not Apply 100% No Deductible Co-pays or Co-insurance will be applied. UnitedHealthcare follows the Preventive Care Services Guidelines Please see Preventive Care Benefits Guideline

80% of the Reasonable Charge after a $100 per visit deductible

50% of the Reasonable Charge $40 per visit deductible 50% of Reasonable Charge if filled at any Non-Preferred Pharmacy 50% of the Reasonable Charge $40 per visit deductible

Psychiatry Office Visits

Preventive Services

No Coverage

The plan will pay benefits in accordance with any applicable Ohio Health Insurance Law. Please read the Bowling Green State University Student Health Insurance Plan brochure carefully for more benefit details. While this document describes important features of the plan, there may be other specifics of the plan that are important to you and some limits to what the plan will pay. If you want to look at the full plan description, which is contained in the Master Policy issued to Bowling Green State University, you may view it at 170 Health Center Building during business hours, or contact us at 419-372-7495. The annual maximum for the Bowling Green State University is $500,000 per illness or injury. The plan also contains other exclusions, limitations and benefit plan maximums. Some illnesses or injuries may cost more to treat and you may be billed for what the plan does not cover.