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Out-Patient Benefits
$100 deductible
For
For injuries
injuries and
and sickness:
sickness: $150
$150 deductible
deductible per
per
insured
person
per
policy
year,
then
80%
of
insured person per policy year, then 80% of
Usual
Usual &
& Customary
Customary (U/C)
(U/C)
Emergency
Emergency Room
Room visits:
visits: $50
$50 deductible
deductible per
per
visit
visit
Preventive
Preventive routine
routine care:
care: covered
covered at
at 100%
100% of
of
billed
billed charges
charges with
with no
no deductible
deductible or
or coinsurance
coinsurance
Prescription
Prescription Drug
Drug Care:
Care: Covered
Covered via
via tiered
tiered copay
copay
(more
(more information
information on
on following
following slide)
slide)
Tier
Includes
Copay
$15
$30
$50
Mostly higher-cost
brand
as well as select
generic
drugs .
Waivers/Opting out
If a student has other equivalent or better health insurance to
the University of Illinois Student Injury and Sickness
Insurance Plan, the student can waive themselves from the
Universitys plan during the Enrollment Change Period at the
beginning of the semester.
The waiver form is found online at www.uhcsr.com/illinois,
under the link entitled waiver form.
Website:
www.uhcsr.com/illinois
The other insurance plan must have at least $500,000 worth of medical coverage
per injury or illness.
The other insurance must have a low deductible (up to $2,000/$5,000 if plan is an
HSA).
The insurance must cover health care received within a 50 mile radius of the
Urbana-Champaign campus.
Effective dates of the other insurance must be on or before the first day of student
coverage; therefore, if the student wishes to do a Waiver during Spring Semester
2017, their other insurance must be effective by January 14, 2017, and must not
terminate before May 12, 2017.