- Medical Benefits
Once you have met your $100 deductible, if you are using a preferred provider, your medical services will be covered at 90%. Non preferred providers are covered at 70%, after your deductible is met.
- Dental Benefits
There is no preferred list of dentists. You will be covered at 100% of usual and customary charges for one cleaning, one exam and one set of x-rays, once every six months, regardless of the dentist you choose. For minor dental services (such as fillings) you will pay a $25 deductible and then 20% of the charges, PacificSource covers 80%. There is no major dental coverage on this plan.
- Prescription Benefits
Prescriptions are covered at 70%. At major chain pharmacies, all you need to do is show your insurance card and pay your 30% co-pay. At the Student Health Center, you will need to show your insurance card, pay 100% of the cost, fill out a prescription reimbursement form, send it to PacificSource, and wait for 70% back. Prescriptions (including birth control) are only covered in 30 day supplies.
- Vision Benefits
You have $200 to spend on vision services. This includes your eye exam, frames, lenses, contacts, etc. Any amount over $200 is your responsibility. Preferred providers are covered at 100%, up to the $200 limit. Non preferred providers are covered at 40%, up to the $200 limit.
For the full listing of benefits, refer to the member packet that you received when you signed up for health insurance. Or take a look at the Benefit Book for 2009-2010: Pacific Source Health Care Handbook.
For specific benefits questions, call PacificSource- 541-684-5582
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