 |
 |
 |
||||
|
||||
|
Health & Dental InsuranceUSU Self-funded Medical PlanAdministered by Blue Cross/Blue Shield
Comparison Summary of Preferred BenefitsHospitalizationWhite Plan: Annual $125 copay 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%. $75 copay per admission for outpatient surgery. Blue Plan: Annual $100 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%. $50 copay per admission for outpatient surgery. Surgery & AnestheticWhite 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 BenefitsWhite Plan: Annual up-front deductible of $250 per person/ $500 per family. $25 per physician visit. $75 per incident for major diagnostic testing. Blue Plan: Annual up-front deductible of $150 per person/$450 per family $20 per physician visit. $50 per incident for major diagnostic testing. PrescriptionsWhite Plan: You pay $7 Generic; $25 Brand with NO Generic Equivalent; $35 Brand with Generic Equivalent 35% coinsurance. Maximum out of pocket of $1,200 per person per year. Blue Plan: You pay $7 Generic; $25 Brand with NO Generic Equivalent; $35 Brand with Generic Equivalent 35% coinsurance. Maximum out of pocket of $1,000 per person per year. Major MedicalWhite Plan: Maximum out of pocket for covered items is $2,000 per person per year/$4,000 per family per year. Maximum lifetime benefit is $2,000,000 per person. Blue Plan: Maximum out of pocket for covered items is $1,500 per person per year/$3000 per family per year. Maximum lifetime benefit is $2,000,000 per person. Non-Preferred BenefitsThis option provides coverage when non-preferred facilities or physician's services are used. Services are paid at a lower level than preferred benefits. Dental InsuranceBasic BenefitsExaminations, fillings, x-rays, sealants, etc., covered at 80% ProstheticsDentures, bridges, crowns, etc., covered at 50% OrthodonticsBenefits are paid at 50% GeneralMaximum benefit per person per contract year on all dental benefits is $1500. Maximum benefit on orthodontics is $1500 per person per lifetime. |
|||
|
||||
|
||||
