Faculty & Staff
Deductible | ||||
---|---|---|---|---|
Salary Range | < $45,000 | $45,000 – $60,000 | $60,000 – $90,000 | > $90,000 |
Individual | $250 | $375 | $500 | $625 |
Family | $500 | $750 | $1,000 | $1,250 |
Coinsurance Out-of-Pocket Maximum | ||||
Individual | $1,250 | |||
Family | $2,500 | |||
Total Out-of-Pocket Maximum | ||||
Individual | $7,150 | |||
Family | $14,300 | |||
Coinsurance | ||||
Percentage | 90% | |||
Services | ||||
Preventive Care | Covered at 100% | |||
Office Visit | $20 copay | |||
Specialist Visit | $30 copay | |||
Urgent Care | $30 copay | |||
Emergency Room (Waived if admitted) | $100 copay | |||
Pharmacy | ||||
Retail (30-day supply) | ||||
Generic Drugs | 50% coinsurance | |||
Formulary Brand Drugs | 50% coinsurance | |||
Non-Formulary Brand Drugs | 70% coinsurance | |||
Mail Order | ||||
Generic Drugs | 20% coinsurance | |||
Formulary Brand Drugs | 20% coinsurance | |||
Non-Formulary Brand Drugs | 70% coinsurance | |||
Specialty | ||||
Formulary Drugs | 50% and $50 Maximum | |||
Non-Formulary Brand Drugs | 70% and $100 maximum | |||
Out-of-Pocket Maximum | $2,000/$8,000 |
More details and overview of coverage grid.
Technical Service Employees
Deductible | |
---|---|
Individual | $250 |
Parent/Child(ren) | $375 |
Family | $500 |
Coinsurance Out-of-Pocket Maximum | |
Individual | $1,000 |
Parent/Child(ren) | $1,500 |
Family | $2,000 |
Total Out-of-Pocket Maximum | |
Individual | $7,150 |
Family | $14,300 |
Coinsurance | |
Percentage | 90% |
Services | |
Preventive Care | Covered at 100% |
Office Visit | $10 copay |
Specialist Visit | $20 copay |
Urgent Care | $20 copay |
Emergency Room (Waived if admitted) | $100 copay |
Pharmacy | |
Retail (31-day supply) | |
Generic Drugs | 50% coinsurance |
Formulary Brand Drugs | 50% coinsurance |
Non-Formulary Brand Drugs | 70% coinsurance |
Mail Order | |
Generic Drugs | 20% coinsurance |
Formulary Brand Drugs | 20% coinsurance |
Non-Formulary Brand Drugs | 70% coinsurance |
Specialty | |
Formulary Drugs | 50% and $50 Maximum |
Non-Formulary Brand Drugs | 70% and $100 maximum |
Out-of-Pocket Maximum | $1,000/$6,000 |
More details and overview of coverage grid.