1. Today’s Lecture U of I Student Injury and Sickness Insurance - Undergraduate Plan 2007-2008 Coverage Deductibles, Coinsurance and Limits Examples

2. 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

3. In-Hospital Expense Benefit $100 Deductible 80% of next $10,000 100% of balance of room and board and other hospital expenses incurred

4. In-Hospital Expense Benefit Example In hospital for 10 days at $500 per day room and board. Total charge: 10 x $500 = $5000 Deductible 100 80% of first $10,0004900 = 3920 Amount payable = $3920

5. 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

6. 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

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

8. 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

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

10. 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

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

12. 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

13. 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%)

14. 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

15. 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

16. 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)

17. 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

18. 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

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

20. 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

21. 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

22. 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