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Domestic Insurance Plan 2013-2014

VENDOR:  STUDENT ASSURANCE SERVICES, INC.

FOR PURCHASING INFORMATION:

  • BEFORE AUGUST 19, 2013:  CALL 800-328-2739
  • AFTER AUGUST 19, 2013: Go to http://www.sas-mn.com/ and select "FIND MY SCHOOL" under "COLLEGES" on the main page. Follow the prompts to find your policy information.

POLICY LIMITS - When the covered Injury or Sickness requires treatment by a Physician, this Policy will provide benefits during the insured’s period of coverage for the Preferred Allowance (PA) when treated by a network provider or the Reasonable and Customary Charges (R&C) when treated by a non-network provider, as noted in Plan.

 

PLAN SUMMARY

Maximum Benefit

$500,000 / Insured Person / Year

Deductible:

UL Lafayette  Student Health Service

Waived for Billable Services

Preferred Providers

$500 / Insured Person / Year

Out of Network Providers

$1,000 / Insured Person / Year

Co-insurance:

Preferred Providers

80% of Preferred Allowance (PA) as Noted in Plan

Out of Network

60% of Reasonable and Customary Charges (R&C) as noted in Plan

 

FEE SCHEDULE

STUDENT ONLY:
Fall and break   $    933.50
Spring and break   $    933.50
Summer and break   $    321.00

ADD SPOUSE:
Fall and break   $ 2,254.50
Spring and break   $ 2,254.50
Summer and break   $    762.00

PER CHILD COVERAGE:
Fall and break   $ 1,488.50
Spring and break   $ 1,488.50
Summer and break   $    506.50

 

PERIODS OF COVERAGE AND ENROLLMENT PERIOD DEADLINE DATES

TERM  

DATE COVERAGE BEGINS DATE COVERAGE ENDS ENROLLMENT PERIOD DEADLINE DATE
FALL SEMESTER 08-18-2013 01-12-2014 09-19-2013
*SPRING SEMESTER 01-13-2014 06-03-2014 02-13-2014
*SUMMER

06-04-2014

 08-17-2014 07-04-2014

*Spring semester or summer may ONLY be purchased by a NEW STUDENT who was not eligible for fall coverage. If you are enrolled in the fall and choose not to purchase this insurance in the fall, you will not have the opportunity to purchase this policy until the FOLLOWING FALL SEMESTER.

IMPORTANT: Enrollment and premium payments received after the enrollment period deadline are NOT accepted (except for new students or late school enrollment).