Health Insurance: Plan Highlights

2013-2014 BENEFIT SUMMARY

(effective 8/1/13 - 7/31/14)

Medical Calendar Year Deductible

Student/Subscriber Pays

Medical Calendar-Year Deductible $150
Annual Out-of-Pocket Maximum Individual/Family $3,000/$6,000


Outpatient Care

Office Visits $40 Copay (deductible waived)
Preventive Exams No Charge (deductible waived)
Maternity/Prenatal Care No Charge (deductible waived)
Well-Child Preventative Care Visits No Charge (deductible waived)
Vaccines (Immunizations) No Charge (deductible waived)
Allergy Injections $5 Copay
Occupational, Physical, and Speech Therapy $40 Copay
Most Labs and Imaging $10 Copay
MRI, CT and PET Scans $50 Copay
Outpatient Surgery 20% Coinsurance


Emergency Services

Emergency Department Visits (waived if admitted directly to hospital) 20% Coinsurance
Ambulance Services $150 Copay


Prescriptions

Generic (Up to a 30-Day Supply) $10 Copay (Deductible Waived)
Brand Name (Up to a 30-Day Supply) $30 Copay (Deductible Waived)
Generic Mail Order Incentive (Up to a 100-Day Supply) $20 Copay (Deductible Waived)
Brand Name Mail Order Incentive (Up to a 100-Day Supply) $60 Copay (Deductible Waived)


Hospice Care

Physician Services, Room and Board, Tests, Medications, Supplies and Therapies 20% Coinsurance
Skilled Nursing Facility Care (Up to 100 Days) 20% Coinsurance


Mental Health Services

Outpatient Visits $40 copay (Individual Therapy, Deductible Waived)
$20 copay (Group Therapy, Deductible Waived)
Inpatient Psychiatric Hospitalization & Intensive Psychiatric Treatment Programs 20% Coinsurance


Chemical Dependency Services

Outpatient Visits $40 copay (Individual Therapy, Deductible Waived)
$5 copay (Group Therapy, Deductible Waived)
Inpatient Detoxification 20% Coinsurance


Other

Certain Durable Medical Equipment (DME) 20% Coinsurance (Deductible Waived)
Vision Exam No Charge (Deductible Waived)
Optical (Eyewear) Not Covered
Home Health Care (Up to 100 Two-Hour Visits Per Calendar Year) No Charge (Deductible Waived)
Hospice Care No Charge (Deductible Waived)

 

This is only a summary of plan features. Please consult the GGU Student Health Insurance Brochure for a more detailed description of plan features, including benefits, exclusions and limitations.