Page 4 - StudentSecure_Products-Comparison

2/4/2019 https://quote.hccmis.com/content/studentsecure/help/PolicyHelpStd.htm#diff

BENEFIT ELITE SELECT BUDGET SMART

Outpatient Generic Drugs: 100% 50% of actual charge (not subject to deductible or
prescription drugs coinsurance coinsurance)
Brand Name Drugs: 50%
coinsurance.
Specialty Drugs: No
coverage.(not subject to
deductible)

Vaccinations Up to $150.Covered No coverage

vaccinations and testing are:

Measles, Mumps, Rubella

(MMR);

Tetanus/Diphtheria/Pertussis

(TDAP); Chicken Pox

(Varicella); Hepatitis B; and

Meningitis (Meningococcal

MCV4 and B) (not subject

to deductible or

coinsurance)

Mental health Outpatient: Maximum of 30 visits. Inpatient: Outpatient: $50 Outpatient: $50
maximum per maximum per
disorders Maximum of 30 days. day, $500 day, $500
maximum. maximum.
(Treatment must not Inpatient: Up to Inpatient: Up to
$10,000 $5,000.
be provided at a maximum.

student health

center)

Dental treatment Up to $250 maximum per tooth; $500 maximum per certificate period. Not subject to
due to accident coinsurance.

Emergency dental Up to $100. Not subject to coinsurance.
(Acute onset of
pain)

Pre-existing 6-month waiting period 12-month waiting No coverage
condition period

Acute onset of pre- $25,000 lifetime maximum for eligible expenses
existing condition
(excludes chronic
and congenital
conditions)

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