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, exculsion 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

2011-2012

 United States Fire Insurance Company

Coverage Acceptance

  Guaranteed

Policy Period

 9/17/11 to 9/17/12

Eligibility

  6 credit hours 

 

Medical

Maximum Benefit/Period

$75,000 per condition

Deductible/Period

$150 per benefit year


Additional Co-Pays

 

Emergency Room

$100-waived if admitted

Doctor Visits

$20 copay within Network

Prescription Maximum

$1,500 per benefit year

Co-Pays-Generic

$10

Brand Name

$20

Non-Formula

$20


Coinsurance-Company Pays 

In-Network

80%

Out of Network

50%

Maximum Out Of Pocket

$3,150 per benefit year

Hospital In Patient

80% in Network

Professional Services

80% in Network

Preventive Care

*see below

Vision

No Benefits

Maternity

Same as other conditions

Routine Dental Care

No Benefits

Global Medical Emergency

Included

Assistance

 

 

 

Accidental Death

$10,000

 

 

Premiums/Rates Per School Period - Based on Per-Day Rates
2011-2012
Rates		Annual
9-17-11
to
9-17-12		Fall
9-17-11
to
1-9-12		Winter
1-9-12
to
4-2-12		Spring
4-2-12
to
6-24-12		Spring/Summer
4-2-12
to
9-17-12		Summer
6-24-12
to
9-17-12

Student

$1,704

$525

$399

$390

$784

$399

Spouse

$4,153

$1,276

$968

$947

$1,912

$968

Per Child

$2,601

$799

$607

$593

$1,197

$607

*Preventive care covered expenses include an annual Pap screening for women ages 18 & older and one baseline mammogram for women between ages of 35 & 40.  Women 40 & older have coverage for an annual mammogram per policy year, subject to co-pays.

**This is not a coverage certificate.  

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. 


© 2012 Eastern Washington University