Student Health Plans
2009-20010
ADDITIONAL INDIVIDUAL
HEALTH INSURANCE OPTIONS
Please consider these additional insurance options for you and your family. The below plans are not associated with your status as a student and are not required. This information is provided as a courtesy.
| |
LIFEWISE
WISECHOICES 30
|
ASURIS
CLARITY 70 |
| Coverage Acceptance |
Medically Underwritten |
Medically Underwritten |
| Policy Period |
Continuous with Payment |
Continuous with Payment |
| Eligibility |
Available to anyone |
Available to anyone |
| MEDICAL |
| Maximum Benefit/Period |
$2 million |
$2 million |
| Deductible/Period |
$1,500 per calendar year |
$3,000 per calendar year |
| ADDITIONAL CO-PAYS |
| Emergency Room |
$100- waived if admitted |
$100- waived if admitted |
| Doctor Visits |
$30 Copay |
$30 Copay |
| Prescription Maximum |
$3,000 benefit limit for brand name only |
$3,000 limit per calendar year for all Rx |
| Co-Pays-Generic |
$10 Copay unlimited |
$10 Copay |
| Brand Name |
$45 |
30% |
| Non-Formulary |
50% |
50% |
|
COINSURANCE - COMPANY PAYS |
| In-Network |
70% |
70% |
| Out of Network |
50% |
50% |
| Maximum Out of Pocket |
$10,000 |
$8,000 |
| Hospital In Patient |
70% in network |
70% in network |
| Professional Visits |
70% in network |
70% in network |
| Preventive Care |
$30 Copay
Screenings - Covered in full |
Deductible waived; $200 per calendar year
Screenings - Deductible waived; subject to $200 preventive max. |
| Vision |
1 exam-covered in full; $200 for hardware; ded. Waived (per 2 years) |
1 exam - $20 copay; $200 hardware |
| Maternity |
30% |
30% |
| Routine Dental Care |
None |
None |
| Global Medical Emergency Assistance |
Incl. |
Incl. |
| Mental Health |
Inpatient - Deductible, then 30% (6 visits per calendar year)
Outpatient - $30 Copay (6 visits per calendar year)
|
Inpatient - 30% (8 visits per calendar year)
Outpatient - 30% (12 visits per calendar year)
|
| Substance Abuse |
Incl. if caused by mental cond. |
Incl. if caused by mental cond. |
| Acupuncture |
Deductible waived. $25 copay (12 visits per calendar year) |
30% (12 visits per calendar year) |
| Spinal Manipulation |
Deductible Waived. $25 copay (12 visits per calendar year) |
30% (12 visits per calendar year) |
| Immunizations |
Covered in Full |
Deductible waived $200 per calendar year |
| Mammogram |
Deductible waived; member pays 30% |
Deductible waived on 1st; 30% |
| Outpatient DX&L |
Deductible; member pays 30% |
30% |
| Rx Mail Order |
Yes (copay 2.5 X 3 mos) |
Yes |
| 24-hour Health Info Line |
Yes |
Yes |
| Ambulance |
Air: No benefit max. Ground: $5000 per calendar year |
Ground only: $2000 per calendar year |
| 24 hour coverage |
Yes |
Yes |
| |
PREMIUMS as of August 2009
Non-smoking rates |
|
LIFEWISE |
ASURIS NW CLARITY 80 |
Age |
Monthly |
Monthly |
| < 25 |
$168 |
$113 |
25 to 29 |
$191 |
$131 |
| 30 to 34 |
$220 |
$153 |
35 to 39 |
$263 |
$179 |
40 to 44 |
$312 |
$214 |
45 to 49 |
$389 |
$261 |
50 to 54 |
$476 |
$304 |
55 to 59 |
$556 |
$361 |
60 to 64 |
$630 |
$421 |
65+ |
$630 |
$421 |
per child |
$141 |
$108 |
Print this page
If you have questions about these two plans, please call Fidelity at 509-462-7877 or 1-800-223-7954 and ask for Maureen Strom.
To Apply for Coverage
To apply for coverage please click on the appropriate logo below.
Definitions
| Deductible |
A deductible is an amount payable by the subscriber for health care before certain contractual benefits are available. Some benefits may be payable without a deductible. |
| Coinsurance |
Student percentage of cost share after the deductible has been met |
| Maximum Out-of-Pocket |
This is the maximum amount a student will pay per contract before the policy will pay 100% thereafter for covered services received. Copays do not apply |
| 
