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
| Service | In-Network | Out-of-Network |
|---|
| Annual Deductible | None | $250 Individual/$500 family |
| Annual Out-of-Pocket Maximum | $3,000 individual/$6,000 family | $6,000 individual/$12,000 family |
Hospital
| Service | In-Network | Out-of-Network |
|---|
| Hospital Room/Semi-Private | 20% Allowed Benefit - 365 days | 40% Allowed Benefit - 365 days |
| Outpatient Surgery | 20% Allowed Benefit | 40% Allowed Benefit |
| Emergency Care (ER) | $50 co pay | $50 co pay |
Physician Services
| Service | In-Network | Out-of-Network |
|---|
| Surgeon | 20% Allowed Benefit | 40% Allowed Benefit |
| Assistant Surgeon | 20% Allowed Benefit | 20% Allowed Benefit |
| Anesthesiologist | 20% Allowed Benefit | 20% Allowed Benefit |
| In-Hospital Medical | 20% Allowed Benefit | 40% Allowed Benefit |
| Office Visits | $20 Co pay | 20% Allowed Benefit |
| Voluntary Second Surgical Opinion | 20% Allowed Benefit | 40% Allowed Benefit |
Medical Services
| Service | In-Network | Out-of-Network |
|---|
| Diagnostic X-rays and lab tests | 20% Allowed Benefit | 40% Allowed Benefit |
| Pre-admission testing | 20% Allowed Benefit | 40% Allowed Benefit |
| Radiation and Chemotherapy | 20% Allowed Benefit | 40% Allowed Benefit |
| Allergy testing and injections | Testing - 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 pay | 20% Allowed Benefit |
| Chiropractic Services | $35 Co pay | 20% Allowed Benefit |
Preventative Care
| Service | In-Network | Out-of-Network |
|---|
| Well Child Care | No charge | 20% Allowed Benefit |
| Annual Physical Exam | No charge | 20% Allowed Benefit |
| Annual Gynecological Exam | No charge | 20% Allowed Benefit |
Special Services
| Service | In-Network | Out-of-Network |
|---|
| Home Health Care Visits | 20% Allowed Benefit | 40% Allowed Benefit |
| Hospice (Facility) | 20% Allowed Benefit | 40% Allowed Benefit |
| Maternity Care | 20% Allowed Benefit | 40% Allowed Benefit |
| Nursery Care | 20% Allowed Benefit | 40% Allowed Benefit |
| Ambulance | 20% Allowed Benefit | 40% Allowed Benefit |
Prescription Drugs
| Service | |
|---|
| Prescription Drugs Including Oral Contraceptives | $15/$35/$60; no deductible
Self-injectable medications- 50% co pay up to a maximum of $100 |
Artificial Insemination/In Vitro Fertilization (AI/IVF)
| Service | In-Network | Out-of-Network |
|---|
| AI/IFV | 20% Allowed Benefit | 40% Allowed Benefit |
Mental Health Services
| Service | In-Network | Out-of-Network |
|---|
| Inpatient Care | 20% Allowed Benefit | 40% Allowed Benefit |
| Outpatient Care (office) | $20 Co pay | 20% 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.
