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| Regular On-Campus & Away-From-Campus Coverage | Extended Coverage | ||
|---|---|---|---|
| Single Student Only | Semester | $270 | $650 per month |
| Block | $135 | ||
| Summer Session | $90 | ||
| Single Student Plus Dependent(s) | Semester | $757 | $991 per month |
| Block | $379 | ||
| Summer Session | $253 | ||
| Married Student Only | Semester | $318 | $650 per month |
| Block | $159 | ||
| Summer Session | $106 | ||
| Married Student Plus Dependent(s) | Semester | $1,085 | $991 per month |
| Block | $543 | ||
| Summer Session | $362 | ||
| Office Visit Fee | Plan Pays After Office Visit Fee (for Covered Services) | You Pay After Office Visit Fee (for Covered Services) |
|---|---|---|
| $10 | 80% | 20% |
| Physician Services, Outpatient Care, and Urgent Care | Hospital Emergency Room | Hospital Admission |
|---|---|---|
| $25 | $50 | $300 |
| Plan Pays After Copayment (Where Applicable) | You Pay After Copayment (Where Applicable) | |
|---|---|---|
| Contracted Providers | 80% | 20% |
| Non-Contracted Providers | 50% | 50% |
*For most covered services. For full details see the Student Health Plan Handbook.
If you are married, you must pay a $750 deductible per person each year before the plan pays benefits. Non-student spouses must also pay a $4,750 deductible for maternity care.
When you see a contracted provider, preventative services covered by the Student Health Plan are offered at no cost to you. For a list of covered preventative services or for more information, please see the Student Health Plan Handbook.
NOTICE TO PLAN PARTICIPANTS
The organization that sponsors your group health plan has certified that it qualifies for a temporary enforcement safe harbor with respect to the Federal requirement to cover contraceptive services without cost sharing. During this one-year period, coverage under your group health plan will not include coverage of contraceptive services.