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 |
