Today’s Lecture U of I Student Injury and Sickness Insurance Plan Undergraduate Plan

1. Today’s LectureU of I Student Injury and SicknessInsurance PlanUndergraduate Plan Benefit Provisions General Limitations Reduction of Benefits Examples

2. Hospital Expense Benefits Room and Board Not to exceed average semi-private room rate $100 deductible applies here Hospital Expenses Operating room, drugs, x-rays, laboratory tests, medical supplies while confined

3. Hospital Expense BenefitsExample Hospitalized for 10 days for meningitis Room and board $500/day (ave. semi-private) Room and board $5000 Drugs $2500 Lab Tests $5000 Medical Supplies $2000 Total hospital expenses $14,500

4. Hospital Expense BenefitsExample You pay $100 deductible Of the remaining $14,400, they pay $8000 (80% of the next $10,000) plus $4400 (all of the amount over $10,100) Amount payable by Student Health Plan: $12,400 You pay $2,100 ($100 deductible plus 20% of $10,000)

5. Durable Medical Equipment Only covered for accidental injury: Splints, casts, crutches and braces Accidental injury must have occurred while insured

6. Dental Lower of: 80% of Usual and Customary or 80% of Actual Charge Deductible applies (if student) Covered only for: • Injury to Sound, Natural Teeth • The removal of bony impacted wisdom teeth • TMJ (Temporo-Mandibular Joint) disorder

7. 2 Addiction, such as nicotine addiction 6 Cosmetic procedures, except cosmetic surgery required to correct an injury... 7 Dental treatment except as specifically provided in the Schedule of Benefits 14 Injury caused by or resulting from the use of alcohol, illegal drugs or any drugs or medicines not taken in the recommended dosage ... 16 Injury sustained participating in interscholastic or professional sport, contest or competition (including traveling or practicing) 18 Participation in a riot or civil disorder; commission of or attempt to commit a felony 23 Routine physical exams ... 26 Suicide or attempted suicide while sane or insane (including drug overdose) or intentionally self inflicted injury General Exclusionsand LimitationsPages 14-15

8. Sports Injuries Page 7 “This plan covers injuries incurred while participating in intercollegiate, club and intramural sports, limited to $75,000.” Page 17 – Intercollegiate Sports Benefit “Insured student athletes who are members of and are participating in intercollegiate sports sponsored by the Policyholder are covered for sports injury.”

9. Example While attempting to rob a bank, you (a student) accidentally shoot yourself in the foot. The police easily catch you as you are trying to hop away. They take you to the emergency room on the way to jail. You are billed $500 for the emergency room. How much does the U of I Student Plan pay? A) 0 B) 240 C) 280 D) 350 E) None of the above

10. Reduction of Benefits Applies when covered person has other valid coverage, specifically: Hospital or Medical Insurance Group Insurance Auto Medical Payments Employee Benefit Plan Does not include third party liability coverage

11. Calculating the Reduction of Benefits Initial Benefit Payment Benefit is reduced by 50% Statement “No more than 100% of the eligible expenses are compensable between this Plan’s benefits and the benefits of any Other Valid Coverage…”

12. Calculating the Reduction of Benefits If the Initial Benefit Payment (under U of I plan) plus other benefits are less than 100% of eligible expenses, then an Additional Benefit Payment will be made. Additional Benefit Payment = the lower of: Normal Benefit - Initial Benefit Payment or 100% of Eligible Expenses - (Initial Benefit Payment + Other Valid Coverage)

13. Example You incur $5200 in Outpatient Miscellaneous Illness and Accident Expenses during the year. Eligible Expenses $5200 Normal Benefit 4040 [(5200-150) x .8 = $4040] Other group insurance pays $2700.

14. Example - (Cont.) Initial Benefit Payment .5 x $4040 = 2020 Other Valid Coverage = 2700 Total 4720 Additional Benefit Payable Lower of 4040 - 2020 = 2020 5200 - 4720 = 480

15. Example - (Cont.) Total Benefit Payable Initial Benefit Payment 2020 Additional Benefit Payment 480 2500 Insured receives $2500 from U of I Plan plus $2700 from the other coverage for a total of $5200, the total expenses.

16. Subrogation This policy has the right to recover any benefits paid if a third party is liable for the sickness or injury. (Page 18) Example Plan pays $25,000 to a student injured in an automobile accident. The total medical bills were $30,000. If the student can collect a bodily injury award of $75,000 from the driver of the vehicle that covers all the medical bills plus pain and suffering, the plan is entitled to recover the $25,000 that it paid.

17. Insurance Premiums by YearUndergraduate Plan

18. Insurance Premiums by YearUndergraduate Plan