Required Coverage Dates Silver Plan
$0.0   Deductible Option
Gold Plan
$0.0   $500.0   Deductible Option
24 & Under 25-29 30 & Above 24 & Under 25-29 30 & Above
ANNUAL 2016-17 $544 $818 $2,242 $588 $877 $2,392
PER MONTH (30-DAY RATE) $45 $68 $185 $46 $76 $197
No Lifetime Limits On Benefits No Lifetime Limits On Benefits
$500,000 per Injury or Sickness $2,000,000 per Person per Policy Year
Coinsurance: 80% In-Network, 70% Out-Network Coinsurance: 80% In-Network, 70% Out-Network
Diagnostic Services and Laboratory Tests Preventive Care Services per ACA - 100% In-Network
Mental Illness & Substance Use Disorder Treatment Mental Illness & Substance Use Disorder Treatment
Prescription Drugs: 70% up $1,000 max per year Prescription Drug Card: $20/$40/$60 copay
Urgent Care Facilities - $50 copay Urgent Care Facilities - $50 copay
Pre-Existing Conditions - Six months waiting period Pre-existing Conditions - $2500 benefit; No exclusion after 6-mos
Evacuation & Repatriation - Pays 100% for services provided Evacuation & Repatriation - Pays 100% for services provided
Review Silver Plan Policy Brochure Review Gold Plan Policy Brochure
All charges shown include premium, credit card transaction fees, ACH processing fees and other cost associated with offering this health plan. The programs offered here are underwritten by Student Resources (SPC) Ltd. A UnitedHealth Group Company. This plan can only be enrolled through www.psiservice.com.



Disclaimer:

"PSI gathered this information as a resource for students, and this does not intend to imply a relationship between your school and our website or company. We advise you to double-check directly with your school to ensure that these Student Plans meet your school's insurance requirements." "We gathered this information as a resource for students, and this does not intend to imply a relationship between your school and our website or company. We advise you to double-check directly with your school to ensure that these Student Plans meet your school's insurance requirements. PSI."