Medical Coverage

Policy Year Maximum: Unlimited

Deductible	Preferred Care	Non-Preferred Care
The policy year deductible is waived for all of the following eligible medical services: In-network care for preventive care and wellness In-network care for pediatric dental care In-network care and out-of-network care for pediatric vision care In-network care and out-of-network care for outpatient prescription drugs	Students: $400 per Policy Year Family: $1,200 per Policy Year	Students: $750 per Policy Year Family: $2,250 Per Policy Year

Deductible

Preferred Care

Non-Preferred Care

The policy year deductible is waived for all of the following eligible medical services:

In-network care for preventive care and wellness
In-network care for pediatric dental care
In-network care and out-of-network care for pediatric vision care
In-network care and out-of-network care for outpatient prescription drugs

Students: $400 per Policy Year
Family: $1,200 per Policy Year

Students: $750 per Policy Year
Family: $2,250 Per Policy Year

Coinsurance: Coinsurance is both the percentage of covered medical expenses that the plan pays, and the percentage of covered medical expenses that you pay. The percentage that the plan pays is referred to as “plan coinsurance” or the “payment percentage,” and varies by the type of expense. Please refer to the Schedule of Benefits for specific information on coinsurance amounts.

Out of Pocket Maximums	Preferred Care	Non-Preferred Care
Once the Individual or Family Out-of-Pocket Limit has been satisfied, Covered Medical Expenses will be payable at 100% for the remainder of the Policy Year. The following expenses do not apply toward meeting the plan’s out-of-pocket limits: Non-covered medical expenses; and Expenses that are not paid or precertification benefit reductions or penalties because a required precertification for the service(s) or supply was not obtained from Aetna.	Individual Out-of-Pocket: $5,000 per Policy Year Family Out-of-Pocket: $10,000 per Policy Year	Individual Out-of-Pocket: $15,000 per Policy Year Family Out-of-Pocket: $30,000 per Policy Year

Out of Pocket Maximums

Preferred Care

Non-Preferred Care

Once the Individual or Family Out-of-Pocket Limit has been satisfied, Covered Medical Expenses will be payable at 100% for the remainder of the Policy Year.

The following expenses do not apply toward meeting the plan’s out-of-pocket limits:

Non-covered medical expenses; and
Expenses that are not paid or precertification benefit reductions or penalties because a required precertification for the service(s) or supply was not obtained from Aetna.

Individual Out-of-Pocket:
$5,000 per Policy Year

Family Out-of-Pocket:

$10,000 per Policy Year

Individual Out-of-Pocket:
$15,000 per Policy Year

Family Out-of-Pocket:

$30,000 per Policy Year