Today’s Lecture U of I Student Injury and Sickness Insurance - Undergraduate Plan Coverage Deductibles, Coinsurance and Limits Examples

Maximum Amount Payable Aggregate $200,000 for each Injury or Sickness Psychiatric and Substance Abuse Treatment $20,000 per lifetime Intercollegiate, Club and Intramural Sports Injuries $75,000 per injury

In-Hospital Expense Benefit $100 Deductible 80% of next $10, % of balance of room and board and other hospital expenses incurred

In-Hospital Expense Benefit Example In hospital for 10 days at $500 per day room and board. Total charge: 10 x $500 = $5000 Deductible % of first $10, = 3920 Amount payable = $3920

In-Hospital Expense Benefit Example 2 In hospital for 30 days at $500 per day room and board. How much does the U of I Student Plan pay? A)0 B)10,000 C)11,920 D)12,900 E)None of the above

Pre-Admission Testing If testing is performed within 7 days of the surgery, it is included under Hospital Expense Benefit. Otherwise, it would be considered an Outpatient Miscellaneous Expense Benefit. Example: Tests performed on October 7 Surgery on October 10 Costs included in In-Hospital Expense Benefit If no surgery was performed, or if it was performed after October 14, then it would be considered an Outpatient Miscellaneous Expense

Surgical Expense Benefit Lower of: 80% of Usual and Customary or 80% of Actual Charge

Surgical Expense Benefit - Example You have surgery and the surgeon charges you $10,000. The Usual and Customary fee is $12,000. How much does the U of I Student Plan pay? A)0 B)8,000 C)9,600 D)10,000 E)None of the above

Assistant Surgeon Expense Benefit Lower of: 80% of Usual and Customary or 80% of Actual Charge

Assistant Surgeon Expense Benefit Example You have surgery and an assistant surgeon charges $3000 (Usual and Customary). How much does the U of I Student Plan pay? A)0 B)2000 C)2400 D)2500 E)None of the above

Anesthesia Expense Benefit Lower of: 80% of Usual and Customary or 80% of Actual Charge

Anesthesia Expense Benefit - Example During surgery, an anesthetist administers anesthesia. You are charged $6000. The Usual and Customary charge is $5000. How much does the U of I Student Plan pay? A)0 B)4,000 C)4,800 D)5,000 E)None of the above

In-Hospital Physician’s Expense Benefit Lower of: 80% of Usual and Customary or 80% of Actual Charge Limited to 1 visit per day If in Intensive Care Unit, pays 50% (not 80%)

In-Hospital Physician’s Expense Benefit - Example You are hospitalized for 2 days; the doctor visits you once each day, charging $200 for each visit (U&C). How much does the U of I Student Plan pay? A)0 B)160 C)200 D)320 E)None of the above

Outpatient Benefits Includes the following benefits (page 8): Surgical Expense Benefit Day Surgery Miscellaneous Assistant Surgeon Expense Benefit Anesthetist Outpatient Expenses Medical Emergency Physician’s Visits X-Rays/Laboratory Tests & Procedures Injections Physiotherapy Chemotherapy and Radiation Therapy

Outpatient Benefits (cont.) Outpatient Expenses Benefit Students have a $150 Deductible per policy year Insured Dependents have no deductible Medical Emergency Room visits have extra $50 deductible per visit Coverage 80% of Usual and Customary or 80% of the actual charge, whichever is less $900 maximum per policy year for Physiotherapy (chiropractic or physical therapy)

Outpatient Expense Benefit - Example You (a student) visit a doctor four times for treatment of mononucleosis. Each visit costs $100 (U&C). In addition, lab tests cost $250. How much does the U of I Student Plan pay? A)0 B)80 C)400 D)520 E)None of the above

Outpatient Expense Benefit – Example 2 You fall off a skateboard and skin your knee. You go to the emergency room to have it treated. You are billed $500 for the emergency room visit (U&C). How much does the U of I Student Plan pay? A)0 B)240 C)280 D)300 E)None of the above

Ambulance Expense Benefit For land ambulance or air ambulance (medical emergency only) 80% of Usual and Customary or 80% of actual charge

Outpatient Diagnostic Procedures For illness or accidental bodily injury, plan pays 80% of lower of U & C or 80% of actual charge up to: CT scans $800 MRI 1200 Nuclear Imaging 782

Psychiatric and Drug Abuse Treatment Inpatient Same as any other illness (but with $20,000 lifetime maximum) Outpatient 50% of charge up to maximum of: $35 per day 45 days per policy year

Psychiatric and Drug Abuse Treatment - Example You visit a psychiatrist 50 times in one year. Each visit is a different day. Each visit costs $100. How much does the U of I Student Plan pay? A)0 B)1575 C)1750 D)2500 E)None of the above