Health & Dental Insurance

USU Self-funded Medical Plan

Administered by Blue Cross/Blue Shield

Comparison Summary of Preferred Benefits

Overview Plan Comparison Wellness
(White)
70/30 Coverage
High Premium
(Blue)
80/20 Coverage
High Deductable
(Health Plan)
80/20 Coverage
BENEFITS PER PLAN YEAR YOU PAY YOU PAY YOU PAY
Preventative Care      
Preventative Care is not subject to deductibles or co-pays $0 $0 $0
Deductible (Ded)      
Per Person
Per Family
$750
$1,500
$500
$1000
$1,500
$3,000
Co-Pays      
Doctor visits
(regular office hours)
Hospitalization
$35 co-pay, after Ded

$250 co-pay, after Ded
$30 co-pay, after Ded

$200 co-pay, after Ded
20% after Ded

20% after Ded
Co-Insurance      
Max Out-of-Pocket
Per Person
Per Family
30% after Ded
$4,000
$8,000
20% after Ded
$3,250
$6,500
20% after Ded
$5,000
$10,000
Diagnostic
X-ray and Lab
After Ded, you pay $0 up to $1,000, thereafter you pay 30% After Ded, you pay $0 up to $1,000, thereafter you pay 20% After Ded, you pay $0 up to $1,000, thereafter you pay 20%
Prescription Drugs      
Generic
Formulary
Non-Formulary
$5
35%
50%
$5
35%
50%
20% after Ded
Rx Co-insurance Maximum      
Per Person
Per Family
$1,750
$3,500
$1,500
$3,000
N/A

Non-Preferred Benefits

This option provides coverage when non-preferred facilities or physician's services are used. Services are paid at a lower level than preferred benefits.

Dental Insurance

Dental Co-Insurance Preventative & Basic paid at 80%
Major paid at 50%
Dental Maximum $1,500 per claimant
Ortho Lifetime Maximum $1,500 per claimant