Student Health and Carefirst Associated Out-of-Pocket Costs

The Student Health Center provides basic Physician services free of charge to UMB students. Free services include routine physicals and sick visits. OBGYN exams are also free of cost to students. Immunizations are administered at the cost of the medication only. Lab tests and all other services are billed to insurance carriers and the student will be billed for any cost not covered by their insurance.

Deductibles for Carefirst Preferred Provider Program

ServiceIn-NetworkOut-of-Network
Annual DeductibleNone$250 Individual/$500 family
Annual Out-of-Pocket Maximum$6,350 individual/$12,700 family$6,350 individual/$12,700 family

Hospital

ServiceIn-NetworkOut-of-Network
Hospital Room/Semi-Private20% Allowed Benefit - 365 days40% Allowed Benefit - 365 days
Outpatient Surgery20% Allowed Benefit40% Allowed Benefit
Emergency Care (ER)$250 co pay$250 co pay

Physician Services

ServiceIn-NetworkOut-of-Network
Surgeon20% Allowed Benefit40% Allowed Benefit
Assistant Surgeon20% Allowed Benefit20% Allowed Benefit
Anesthesiologist20% Allowed Benefit20% Allowed Benefit
In-Hospital Medical20% Allowed Benefit40% Allowed Benefit
Office Visits$20 Co pay20% Allowed Benefit
Voluntary Second Surgical Opinion20% Allowed Benefit40% Allowed Benefit

Medical Services

ServiceIn-NetworkOut-of-Network
Diagnostic X-rays and lab tests20% Allowed Benefit40% Allowed Benefit
Pre-admission testing20% Allowed Benefit40% Allowed Benefit
Radiation and Chemotherapy20% Allowed Benefit40% Allowed Benefit
Allergy testing and injectionsTesting - 20% Allowed Benefit
Injections - $20 co pay
40% Allowed Benefit
20% Allowed Benefit
Physical, Speech, and Occupational Therapy
(50 visits each calendar year)
$35 Co pay20% Allowed Benefit
Chiropractic Services$35 Co pay20% Allowed Benefit

Preventative Care

ServiceIn-NetworkOut-of-Network
Well Child CareNo charge20% Allowed Benefit
Annual Physical ExamNo charge20% Allowed Benefit
Annual Gynecological ExamNo charge20% Allowed Benefit

Special Services

ServiceIn-NetworkOut-of-Network
Home Health Care Visits20% Allowed Benefit40% Allowed Benefit
Hospice (Facility)20% Allowed Benefit40% Allowed Benefit
Maternity Care20% Allowed Benefit40% Allowed Benefit
Nursery Care20% Allowed Benefit40% Allowed Benefit
Ambulance20% Allowed Benefit40% Allowed Benefit

Prescription Drugs

Service
Prescription Drugs Including Oral Contraceptives$15/$50/$60; no deductible
Self-injectable medications- 50% co pay up to a maximum of $100

Artificial Insemination/In Vitro Fertilization (AI/IVF)

ServiceIn-NetworkOut-of-Network
AI/IFV20% Allowed Benefit40% Allowed Benefit

Mental Health Services

ServiceIn-NetworkOut-of-Network
Inpatient Care20% Allowed Benefit40% Allowed Benefit
Outpatient Care (office)$20 Co pay20% Allowed Benefit

% indicates what the student pays. Co pays are the student's responsibility.

This chart contains highlights only and is subject to change. The specific terms of coverage, exclusions and limitations are contained in the Group Benefit Guide or the Group Contract.