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Student Health Costs To enroll for health insurance go to http://www.umaryland.benelogic.com
Table I: Student Health and CareFirst Options and Associated Out-of-Pocket Costs
Table II: Student Health, CareFirst, and Dental Plan Coverage Costs
Table III: Student Dental Plan Services and Associated Out-of-Pocket Costs
Blue Vision Plus Rates Table I: Student Health Care Options and Associated Out-Of-Pocket Costs*Service
| Student Health (Services available to all registered students except evening law; fee included in tuition.) | CareFirst Plan
Preferred Provider Option | CareFirst Plan
Out-of-Network Provider | Annual deductible | $0 | Individual=$0
Family=$0 | Individual=$250
Family=$500 | Annual out-of pocket maximum | None | Individual=$2,500
Family=$5,000 | Individual=$5,000
Family=$10,000 | Lifetime maximum benefits paid | No limit | No limit | No limit | What's Covered? | Routine exams and office visits | Free (visit only) | $20 copay, one per year | 40% of allowed costs after deductible; one per year | Physician sick visit | Free | $20 copay | 40% of allowed costs after deductible | Allergy shots | Free | $20 per injection | As above | Routine blood pressure screening | Free | One per year | One per year | Routine gynecological exam | Free (visit only; lab work billed to insurance) | $20 copay, one per year | 40% of allowed costs after deductible, one per year | Family planning | Free | Not covered | Not covered | Prescription drugs | Not covered | $15 generic, $35 formulary, $60 brand, nonformulary
(self injectable medication, 50% up to max $100 benefit), $5,000 max annual) | $15 generic, $35 formulary, $60 brand, nonformulary
(self injectable medication, 50% up to max $100 benefit), $5,000 max annual) | Birth control pills
Nuvaring | Discounted with gynecological exam | $15 generic, $35 formulary, $60 brand, nonformulary, Max. applies | $15 generic, $35 formulary, $60 brand, nonformulary, Max. applies | Immunizations | Administered at cost | 20% of allowed costs | 40% of allowed costs | Mental Health | Free short-term counseling at the Counseling Center for all registered students | Inpatient: 20% of allowed costs, 365 days per year; precertification required.
Detox: 20% of allowed costs.
Outpatient substance abuse: 20% of allowed costs.
Outpatient mental health: 20% of allowed costs (visits 1 through 5); 35% of allowed costs (visits 6 through 30); 50% of allowed costs (visit 31 on). | Inpatient: 40% of allowed costs after deductible, 365 days per year; precertification required.
Detox: 40% of allowed costs after deductible.
Outpatient substance abuse: 40% of allowed costs after deductible.
Outpatient mental health: 20% of allowed costs (visits 1 through 5); 35% of allowed costs (visits 6 through 30); 50% of allowed costs (visit 31 on) after deductible | Accidental injury: outpatient care | Free | $0 if care is received within 72 hours | $0 if care is received within 72 hours | Emergency room visits | Not covered** | $0 if for a CareFirst recognized emergency | $0 if for a CareFirst recognized emergency | Outpatient surgery | Not covered** | 20% of allowed costs | 40% of allowed costs after deductible | Maternity care | Not covered** | 20% of allowed costs | 40% of allowed costs after deductible | Anesthesia | Not covered** | 20% of allowed costs
| 20% of allowed costs after deductible | Diagnostic testing: X-rays, lab and blood tests, machine tests | Not covered**
| 20% of allowed costs
| 40% of allowed costs after deductible | Hospitalization, including semi-private room, supplies, and care | Not covered** | 20% of allowed costs; precertification required | 40% of allowed costs after deductible; precertification required | Physical, speech, and occupational therapy | Not covered** | $35, precertification required | 40% of allowed costs after deductible; precertification required | *This is not a complete listing of services. Call CareFirst or Student Accounting to inquire about other services. In the event that the costs or services listed here differ from information in official publications, the latter shall take precedence. **Family Medicine physicians at Student Health can perform these services and will bill your insurance company (CareFirst or the equivalent plan you used to waive CareFirst coverage). If you are covered by an alternate plan, you must follow plan guidelines. Family Medicine physicians participate in many plans and can be selected as your primary care provider if they participate in your plan. Back to Top Table II: Student Health, CareFirst, and Dental Plan Coverage Costs*Participants | Student Health Plan | CareFirst Health Plan** | Dental Plan*** | Student | Included in tuition | $1,152.00 per semester | Plan 1: $179.97 per semester
Plan 2: $148.68 per semester | Student and Child | Coverage for student only | $2,592.00 per semester | N/A | Student and Spouse | Coverage for student only | $3,456.00 per semester | N/A | Student and Family | Coverage for student only | $4,437.00 per semester | N/A | *Premiums are not refundable. **Fall coverage begins Aug. 1 and runs through Jan. 31. Spring coverage begins Feb. 1 and runs through July. 31. ***Students can enroll in a dental plan at the beginning of any month during the semester; rates will not be prorated, but the participant will be eligible for a full six months of benefits. Policy dates are Aug 1 - Jan 31 and Feb 1 - July 31. Back to Top Table III: Student Dental Plan Services and Associated Out-Of-Pocket CostsService | Plan 1 | Plan 2 | Class I: preventive (e.g., cleaning, X-rays) | No charge | No charge | Class II: basic restorative (e.g., fillings) | 20% of the fee schedule | 35% of the fee schedule | Class III: periodontal and oral surgery (e.g. extractions) | 50% of the fee schedule | 75% of the fee schedule | Class IV: prosthetic and endodontic (e.g., dentures, crowns) | 50% of the fee schedule | 75% of the fee schedule | Class V: orthodontics | Available at a discounted fee, but not covered | Available at a discounted fee, but not covered | Annual maximum benefit per participant* | $1,250.00 | $1,500.00 | *Benefits used in the first six months cannot exceed one-half of the annual benefit. Any unused benefit will carry forward from the fall to the spring semester. Back to Top
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