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Student Medical Benefit Rates

Dependent Medical Benefit Rates


Plan TypeSemester
Dependent of single student$150
Dependent of married student$500

Coverage for services provided in the Health Center

Co-payment per Service(You Pay)You pay after co-paymentThe plan pays after co-payment

$10

($15 for after-hours)

$0100%

Coverage for physician services outside the Health Center and hospital outpatient care*

Co-payment per Service

(You Pay)

You pay after co-paymentThe plan pays after co-payment
$25

20%for contract providers

50% for non-contract providers

80%**for contract providers

50% for non-contractproviders

Coverage for hospital inpatient care

Co-payment per Service (You Pay)

You pay after

co-payment

The plan pays after co-payment

$200 (Plus $50 for

newborn child)

20%for contract providers

50% for non-contract providers

80% for contract providers

50% for non-contract providers

Obtain written referral from the Health Center before receiving outside care

The maximum benefit is $30,000 per academic year. For coverage of medical expenses above the maximum benefit, refer to BYU-Hawaii's Large Claims Coverage Plan.

Rates are subject to change without notice. Maternity insurance is included for married, full-time students who are enrolled in the plan. Contact the Student Health Center for information about the special contract process for prenatal care and deliveries. Benefits for all services outside the Student Health Center are based on a lesser of billed charges, contracted rates, or the maximum allowable charges for the services received as determined by DMBA.