Northern Illinois University

Student Health Insurance

Summary of Health Plan Benefits

Student Lifetime Maximum $250,000
Deductible $250 of covered Medical Expenses per Policy year per student
Deductible –
Emergency Room
$100 per visit (In addition to the $250 Policy year deductible)
Out of Pocket Maximum $5,000 per policy year excluding deductible for services at Preferred Provider hospitals only (IP and OP)
Pre-existing Conditions No benefits paid on pre-existing conditions except for students who have been continuously insured under the school’s plan for at least 12 consecutive months.
Hospital Benefits Preferred Provider: 80% of preferred allowance
Non-Preferred Provider: 60% of Usual & Customary Charges
Physician’s Benefits Preferred Provider: 80% of preferred allowance
Non-Preferred Provider: 80% of Usual & Customary Charges
Emergency Care -
Medical Emergencies only
Preferred Provider: 80% of preferred allowance
Non-Preferred Provider: 80% of Usual & Customary Charges
Diagnostic & Lab Services Preferred Provider: 80% of preferred allowance
Non-Preferred Provider: 80% of Usual & Customary Charges
Physical Therapy - $3,000 maximum/policy year Preferred Provider: 80% of preferred allowance
Non-Preferred Provider: 80% of Usual & Customary Charges
Prescription Drugs Inpatient: 80% of actual charges
Outpatient: Not Covered
Mental Health Care & Drug Abuse Inpatient: 30 days maximum per policy year
Outpatient: 25 visits maximum per policy year
  Outpatient Preferred Provider: 80% of preferred allowance
Outpatient Non-Preferred Provider: 80% of Usual & Customary Charges
Alcoholism Care Benefits are subject to Hospital benefits levels shown above
  Inpatient Preferred or Non-preferred: Paid as any other sickness
Outpatient Preferred Provider: 80% of preferred allowance
Outpatient Non-Preferred Provider: 80% of Usual & Customary Charges
Skilled Nursing Facility Limited to a maximum of 120 days of confinement per Policy Year
  Preferred Provider: 80% of preferred allowance
Non-Preferred Provider: 80% of Usual & Customary Charges
Home Health Care Limited to a maximum of 40 visits per policy year
  Preferred Provider: 80% of preferred allowance
Non-Preferred Provider: 80% of Usual & Customary Charges
Other Covered Medical Expenses Preferred Provider: 80% of preferred allowance
Non-Preferred Provider: 80% of Usual & Customary Charges