White Plan: Annual $250 co-pay for the first hospital admission. Benefits are paid at 70% for room, board and ancillary charges after initial admission fee. Subsequent hospitalization is paid at 70%. $250 co-pay per admission for outpatient surgery.

Blue Plan: Annual $200 copay for the first hospital admission. Benefits are paid at 80% for room, board and ancillary charges after initial admission fee. Subsequent hospitalization is paid at 80%. $200 copay per admission for outpatient surgery.

Surgery & Anesthetic

White Plan: Benefits are paid at 70% for inpatient and outpatient surgery. Hospital physician visits are paid at 70%.

Blue Plan: Benefits are paid at 80% for inpatient and outpatient surgery. Hospital physician visits are paid at 80%.

Medical & Extended Benefits

White Plan: Annual up-front deductible of $750 per person/ $1,500 per family. $35 per physician visit. $150 per incident for major diagnostic testing.

Blue Plan: Annual up-front deductible of $500 per person/$1,000 per family $30 per physician visit. $100 per incident for major diagnostic testing.

Prescriptions

White Plan: You pay $5 Generic; 35% Formulary; 50% Non-Formulary. Maximum out of pocket of $1,500 per person per year.

Blue Plan: You pay $5 Generic; 35% Formulary; 50% Non-Formulary. Maximum out of pocket of $1,250 per person per year.

Major Medical

White Plan: Maximum out of pocket for covered items is $3,000 per person per year/$6,000 per family per year. Maximum lifetime benefit is $2,000,000 per person.

Blue Plan: Maximum out of pocket for covered items is $2,500 per person per year/$5000 per family per year. Maximum lifetime benefit is $2,000,000 per person.

High Deductible Plan

Annual deductable $1,500 p/person $3000 p/family. Coverage of 80% after deductable is met. Maximum out of pocket max is $5,000 p/person $10,000 family. Prescription coverage at 80% after deductable is met. Option to participate in Health Savings Account (HSA)

Non-Preferred Benefits

This option provides coverage when non-preferred facilities or physicians' services are used. Services are paid at a lower level than preferred benefits.

Dental Insurance

Basic Benefits

Examinations, fillings, x-rays, sealants, etc., covered at 80%

Prosthetics

Dentures, bridges, crowns, etc., covered at 50%

Orthodontics

Benefits are paid at 50%

General

Maximum benefit per person per contract year on all dental benefits is $1500. Maximum benefit on orthodontics is $1500 per person per lifetime.

Other Benefits

Contact Information

Health & Dental Insurance

USU Self-funded Medical Plan

Comparison Summary of Preferred Benefits

Hospitalization