2011-2012 Full Benefits Summary - Office of Student Health Benefits

Boynton Health Service Physician Services BenefitsThe Student Health Benefit Plan Covers:• Professional charges for outpatient treatmentrendered at Boynton Health Service when insuredhas paid Student Services FeeBoynton Health Service100%The Student Health Benefit PlanCovers:Physician ServicesIn-Network ProvidersOut-of-Network Providers• Office visit for illness• Office visit for Urgent Care80% 80%, plus you pay any chargesbilled to you that exceed theallowed amount• E-Visit• Allergy testing and injections• Diabetes outpatient selfmanagementtraining andeducation, including medicalnutrition therapy• Lab and diagnostic imaging• Inpatient hospital/facility visitsduring a covered admission• Outpatient hospital/facility visits• Anesthesia by a provider otherthan the operating, delivering,or assisting provider• Surgery• Assistant surgeon• Injectable drugs administeredby a health care professional• Palliative care• Retail Health Clinic servicesincluding lab and diagnosticimaging100% after you pay the RetailHealth clinic copay.100% after you pay the RetailHealth clinic copay, plus you payany charges billed to you thatexceed the allowed amount.54