| Brochure & Details links |
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| COVID-19 |
| No Coverage |
Covered as any other illness |
Covered as any other illness |
Covered as any other illness |
| Pre-existing Conditions Waiting Period |
| No Coverage |
$500 maximum per certificate period; 12 months waiting period |
12 months waiting period |
6 months waiting period |
| Maximum per injury or illness |
| $100,000 |
$100,000 |
$300,000 |
$500,000 |
| Overall Maximum Limit |
| $200,000 |
$200,000 |
$600,000 |
$3,000,000 |
| Deductible (except emergency room) |
| $250 in network / $500 out of network |
$100 in network / $250 out of network |
$50 in network / $150 out of network |
$25 in network / $100 out of network |
| ER Deductible |
| $500 per incident |
$350 per incident |
$250 per incident |
$100 per incident |
| Coinsurance inside the U.S. |
In network: 80% after deductible, up to overall maximum limit
Out of Network: Plan pays 100% |
In network: 80% after deductible, up to overall maximum limit
Out of Network: Plan pays 100% |
In network: 80% after deductible, up to $25,000, then overall maximum limit
Out of Network: Plan pays 100% |
In network: 80% after deductible, up to $10,000, then overall maximum limit
Out of Network: Plan pays 100% |
| Coinsurance outside the U.S. |
| Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
| Local Ambulance |
| $300 per injury or illness |
$350 per injury or illness |
$350 per injury or illness |
$350 per injury or illness |
| Prescription Drugs |
| For outpatient prescription 50% of actual charges |
$30 deductible for generic drugs
$100 deductible for brand name |
$15 deductible for generic drugs
$50 deductible for brand name |
$15 deductible for generic drugs
$30 deductible for brand name |
| Wellness |
| Not Avaliable |
100% of one routine physical exam per member |
100% of one routine physical exam per member |
100% of one routine physical exam per member |
| Dental Treatment due to Accident |
| Not Available |
Not Available |
$1,000 maximum per certificate period |
$1,000 maximum per certificate period |
| Dental Treatment due to Alleviate pain |
| Not Available |
Not Available |
$100 |
$100 |
| Intercollegiate Interscholastic, Intramural or club sports |
| Not Available |
Not Available |
Not Available |
Optional Buy-Up: $10,000 |
| Terrorism |
| Not Available |
Not Available |
Up to $50,000 lifetime maximum |
Up to $50,000 lifetime maximum |
| Accidental Death and Dismemberment |
| Not Available |
Up to $5,000 lifetime maximum |
Up to $25,000 lifetime maximum |
Up to $25,000 lifetime maximum |
| Emergency Reunion |
| Up to $1,500, maximum of 15 days |
Up to $2,500, maximum of 15 days |
Up to $2,500, maximum of 15 days |
Up to $5,000, maximum of 15 days |
| Emergency Medical Evacuation |
| $50,000 lifetime maximum |
$250,000 lifetime maximum |
$500,000 lifetime maximum |
$500,000 lifetime maximum |
| Sports & Activities - Leisure, Recreational,
Entertainment, or Fitness |
| Up to the overall maximum limit |
Up to the overall maximum limit |
Up to the overall maximum limit |
Up to the overall maximum limit |
| Outpatient Treatment |
| Up to the overall maximum limit |
Up to the overall maximum limit |
Up to the overall maximum limit |
Up to the overall maximum limit |
| Mental Health Disorders (excludes drug
abuse and alcohol abuse)
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Treatment must not be provided at a student health center.
Outpatient: $50 maximum per day, $500 maximum.
Inpatient: Up to $5,000 |
Treatment must not be provided at a student health center.
Outpatient: $50 maximum per day, $500 maximum.
Inpatient: Up to $5,000 |
Treatment must not be provided at a student health center.
Outpatient: $50 maximum per day, $500 maximum.
Inpatient: Up to $10,000 |
We will pay:
Within the PPO: 80% of eligible expenses, after the
deductible, up to the overall maximum.
Outside the PPO: Usual, reasonable, and customary up to
the overall maximum. You may be responsible for any
charges exceeding the payable amount.
Outside the U.S.: 100% coinsurance, after the deductible,
up to the overall maximum.
Outpatient: Maximum of 30 visits.
Inpatient: Maximum of 30 days.
Treatment must not be provided at a student health center. |
| Maternity Care for a Covered Pregnancy |
| Not Available |
We will pay:
Within the PPO: 80% of eligible expenses, after the
deductible, up to $8,000.
Outside the PPO: Usual, reasonable, and customary up to
$8,000. You may be responsible for any charges exceeding
the payable amount.
Outside the U.S.: 100% coinsurance, after the deductible, up
to $8,000 |
We will pay:
Within the PPO: 80% of eligible expenses, after the deductible,
up to $15,000.
Outside the PPO: Usual, reasonable, and customary up to
$15,000. You may be responsible for any charges exceeding
the payable amount.
Outside the U.S.: 100% coinsurance, after the deductible, up
to $15,000. |
We will pay:
Within the PPO: 80% of eligible expenses, after the
deductible, up to $25,000.
Outside the PPO: Usual, reasonable, and customary up to
$25,000. You may be responsible for any charges exceeding
the payable amount.
Outside the U.S.: 100% coinsurance, after the deductible, up
to $25,000. |
| Nursery Care of Newborn |
| Not Available |
Up to $250 - not subject to coinsurance |
Up to $750 - not subject to coinsurance |
Up to $750 - not subject to coinsurance |
| Therapeutic Termination of Pregnancy |
| Not Available |
Up to $500 - not subject to coinsurance |
Up to $500 - not subject to coinsurance |
Up to $500 - not subject to coinsurance |
| Personal Liability |
| Not Available |
Not Available |
Not Available |
Up to $150,000 lifetime maximum
Up to $150,000 third person injury
Up to $150,000 third person property
$1,500 related third person property
- not subject to deductible, coinsurance, or overall maximum
limit |
| Repatriation of Remains |
| Up to $25,000 lifetime maximum |
Up to $25,000 lifetime maximum |
Up to $25,000 lifetime maximum |
Up to $50,000 lifetime maximum |
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