Out of Pocket Costs and Definitions

Out of Pocket Costs

When using the Brown University Student Health Insurance Plan, you may encounter some out of pocket expenses:

  • There is a $300 deductible per person, per policy year. However it is waived for 
    • Emergency Room visits
    • Diagnostic X-Rays and Laboratory Tests when ordered by Health Services
    • Outpatient mental health visits
    • Physician office visits
    • In-network preventative screening/lab
    • Outpatient prescription drugs
    • Other outpatient services when provided by University Health Services
  • There is a $100 copay for inpatient hospitalization or outpatient surgery performed at a hospital or hospital affiliated surgical center. This is in addition to the $300 deductible.
  • Doctor visits have a $15 copay.
  • Emergency Room visits have a $100 copay.
  • Urgent Care Center visits have a $25 copay.
  • After a copay, prescriptions will be covered at 100% (in network). Copays are $15, $30 or $50.
  • You will be charged co-insurance when using out-of-network providers. 

Helpful Definitions

Copay - A specified dollar amount an insured person must pay for specific services. Copay is per date of service, per visit or per prescription.

Deductible - A specified dollar amount an  insured person must pay before the insurance company will pay a claim. Deductible is once per policy year. 

Co-insurance- An insured person and the insurance company share the payment made against a claim, which may be in addition to a copay  (For example:  for out-of-network providers covered at 70%, you would pay 30% co-insurance.)

Preferred Allowance - The amount a preferred provider will accept as payment in full for covered services. 

Usual and Customary Charges - The average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided. 

Preferred Providers - The physicians, hospitals and other health care providers who have contracted to provide specific medical care at negotiated prices. 

Out-of-Network Providers -  Providers have not agreed to any prearranged fee schedules.