Today s Lecture U of I Student Injury and Sickness Insurance Undergraduate Plan 2007 2008 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 10 000 100 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 100 80 of first 10 000 4900 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
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