|
IMPORTANT
INFORMATION
|
|
ON
THE
|
|
SOMA
COLLEGE MEDICAL INSURANCE PLANS
|
|
| For
a number of years, the Student Osteopathic Medical Association has
provided its members with |
| a
health insurance program which served as an alternative to school
insurance programs. |
| The
Board of Trustees has approved significant and substantial changes
since inception of the plan, |
| which
now makes it one of the very best insurance programs available to
medical school professionals. |
| The
SOMA College Health Insurance Plan now offers a number of medical
insurance alternatives |
| at
the lowest possible cost, in addition to a dental and vision
insurance option. |
|
| PLEASE
NOTE: After the $250 deductible, the
accident and sickness (medical) insurance plan |
| has
an 80%/60% co-insurance feature, however, we would like to call your
attention to the maximum |
| limits
per policy year on the following charges for Plan 1. |
|
The
deductible does not apply to:
|
| 1)
Prescription Drugs which has a $15 Tier 1/$25 Tier 2 co-pay
under Plan 1 subject to the maximum; |
| 2)
Wellness Benefits; |
| 3)
Doctor Office Visit In-Network. |
| Under
Plan 2 (High Deductible) - a $2,000 deductible must be satisfied
before the plan pays |
| any
covered
charges. |
| |
Plan
1 |
Plan
2 |
|
In
patient Covered Charges |
Preferred
Provider
|
Out-of
Network
|
Preferred
Provider
|
Out-of
Network
|
|
1.
Hospital Expenses
|
80%
up to
$1,500
per
day
|
60%
up to
$1,500
per
day
|
80%
|
60%
|
2. Doctor's Fee for 2nd surgical
Procedure Performed After
Primary Surgery |
50% of
primary |
50% of
primary |
50% of
primary |
50% of
primary |
3. Psychotherapy
|
$25 per day/ 3 Day Maximum |
$25 per day/ 3 Day Maximum |
80% |
60% |
|
|
Out-Patient
Benefit
Maximum
|
Preferred
Provider |
Out-of
Network |
Preferred
Provider |
Out-of
Network |
|
1.
Day Surgery |
80%
up
to
$1,500
|
60%
up
to
$1,500
|
80%
|
60%
|
| 2.
Out Patient Miscellaneous |
$2,000 |
$2,000 |
80% |
60% |
| 3.
Pre Admission Testing |
$1,500 |
$1,500 |
80% |
60% |
| 4.
Injections |
$1,500 |
$1,500 |
80% |
60% |
|
5.
Prescription Drugs
(Per Policy Year)
|
$500
|
No
Benefits
|
80%
|
No
Benefits
|
|
6.
Durable Medical Equipment
|
$1,500
|
80%
up
to
$1,500
|
80%
|
80%
|
|
7.
Psychotherapy
|
50%
up
to
$1,500
|
50%
up
to
$1,500
|
50%
|
50%
|
|
| This
policy is excess to any other insurance policy you may have.
No benefit of this policy is payable |
| for
any expense incurred for Injury or Sickness which is paid or
payable by other valid and |
| collectible
insurance. This excess provision will not be applied to
the first $100.00 of medical |
| expenses
incurred. This plan issued to SOMA is a one year
non-renewable term policy. |
|
| HOW
TO APPLY |
| Select
Online Enrollment Form from Menu Bar at left |
|
