Optional Student Medical Insurance

To purchase this coverage online please visit Fidelity Ins and click on "EWU STUDENT HEALTH", select EASTERN WASHINGTON UNIVERSITY and you will be directed to the above program. A full description of coverage, terms, benefits, exclusion and limitations** can also be found at the above website. 

QUESTIONS?  CALL FIDELITY 509-747-3121 OR 1-800-223-7954 AND ASK FOR THE EWU STUDENT MEDICAL REPRESENTATIVE

2012-2013

 United States Fire Insurance Company

Coverage Acceptance

  Guaranteed

Policy Period

 9/17/12 to 9/17/13

Eligibility

  6 credit hours 

 

Medical

Maximum Benefit/Period

$100,000 per condition

Deductible/Period

$200 per policy year


Additional Co-Pays

 

Emergency Room

80% of Actual Expenses

Doctor Visits

80% of Preferred Allowance within Network

Prescription Maximum

$100,00 per policy year

Prescription Drugs

80% of Actual Expenses at preferred pharmacy

Contraceptive Drugs

100% covered

 

 


Coinsurance-Company Pays 

In-Network

80%

Out of Network

60%

 

 

Hospital In Patient

80% in Network

Professional Services

80% in Network

Preventive Services Benefits

*see below

Vision

No Benefits

Maternity

Same as other conditions

Routine Dental Care

No Benefits

Global Medical Emergency Assistance

Included

 

 

 

 

Accidental Death

$10,000

 

 

Premiums/Rates Per School Period - Based on Per-Day Rates
2011-2012
Rates		Annual
9-17-12
to
9-17-13		Fall
9-17-12
to
1-1-13		Winter
1-1-13
to
4-1-13		Spring
4-1-13
to
6-23-13		Spring/Summer
4-1-13
to
9-17-13		Summer
6-23-13
to
9-17-13

Student

$1,773

$559

$408

$408

$821

$419

Spouse

$3,756

$1,183

$865

$865

$1,739

$885

Per Child

$2,599

$819

$598

$598

$1,204

$613

*Preventive Services Benefits includes preventive services such as screenings, exams and immunizations as specified by the Patient Protection and Affordable Care Art (PPACA).  To view a list of covered preventive services, visit http://www.healthcare.gov/prevention/index.html. Not subject to deductible, copay or coinsurance.

**This is not a coverage certificate.  The coverage is optional to purchase for any student taking 6 or more credits.

FOR A FULL DESCRIPTION OF COVERAGE, TERMS, BENEFITS, EXCULSIONS AND LIMITATIONS OR TO PURCHASE THIS COVERAGE ONLINE, PLEASE VISIT THE WEB SITE OF OUR BROKER, FIDELITY ASSOCIATES Fidelity Ins AND CLICK ON "EWU STUDENT HEALTH", SELECT EASTERN WASHINGTON UNIVERSITY AND IT WILL DIRECT YOU TO THE ABOVE PROGRAM. 

QUESTIONS?  CALL FIDELITY 509-747-3121 OR 1-800-223-7954 AND ASK FOR THE EWU STUDENT MEDICAL REPRESENTATIVE. 


© 2013 Eastern Washington University