Covid19 Coverage |
Includes coverage for eligible COVID-19-related medical expenses. |
Includes coverage for eligible COVID-19-related medical expenses. |
Period of Coverage |
5 days to 364 days |
5 days to 364 days |
Medical Expense Options |
$500,000, $1,000,000, or $2,000,000 |
$500,000, $1,000,000, or $2,000,000 |
Deductible Options |
$0, $250, $500, $1,000, or $2,500 per certificate period |
$0, $250, $500, $1,000, or $2,500 per certificate period |
Coinsurance – Claims Incurred in the U.S. |
- In-Network Payment - 100% after deductible, up to the overall the overall maximum
- Out of network payment - Usual, reasonable and customary. You may be responsible for charges exceeding payable amount
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- In-Network Payment - 100% after deductible, up to the overall the overall maximum
- Out of network payment - Usual, reasonable and customary. You may be responsible for charges exceeding payable amount
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Coinsurance – Claims Incurred outside the U.S. |
Plan pays 100% after deductible, up to the overall maximum limit |
Plan pays 100% after deductible, up to the overall maximum limit |
Hospital Room and Board |
Average semi-private room rate, including nursing services |
Average semi-private room rate, including nursing services |
Intensive Care Unit |
Up to the overall maximum limit |
Up to the overall maximum limit |
Local Ambulance |
Usual, reasonable and customary charges |
Usual, reasonable and customary charges |
Emergency Room Co-payment |
Claims incurred in U.S.: $250 co-pay for emergency room for an illness unless you are admitted to the hospital. No co-pay for emergency room treatment of an injury. Claims incurred outside the U.S.: No co-payment.
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Claims incurred in U.S.: $250 co-pay for emergency room for an illness unless you are admitted to the hospital. No co-pay for emergency room treatment of an injury. Claims incurred outside the U.S.: No co-payment.
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Acute Onset of Pre-existing Condition(excludes chronic and congenital conditions) |
Under age 60 up to $200,000 For age 60 to 69 years up to $20,000 |
Under age 60 up to $200,000 For age 60 to 69 years up to $20,000 |
Outpatient Physical Therapy and Chiropractic Care |
Usual, reasonable and customary charges. Must be ordered in advance by a physician |
Usual, reasonable and customary charges. Must be ordered in advance by a physician |
Emergency Dental Treatment |
Up to $1,000 due to accident and up to $100 for acute onset of pain |
Up to $2,000 due to accident and up to $200 for acute onset of pain |
Urgent Care Facility Co-payment |
Claims incurred in the U.S.: Up to $25 co-pay for urgent care center. (Copay not applicable when $0 deductible is selected) Claims incurred in the U.S.: No co-payment.
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Claims incurred in the U.S.: Up to $50 co-pay for urgent care center. (Copay not applicable when $0 deductible is selected) Claims incurred in the U.S.: No co-payment.
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Accidental Death & Dismemberment |
Under age 18 up to $5,000 lifetime maximum and age 18 to 69 up to $50,000 lifetime maximum. $250,000 maximum benefit any one family or group |
Under age 18 up to $5,000 lifetime maximum and age 18 to 69 up to $50,000 lifetime maximum. $250,000 maximum benefit any one family or group |
Emergency Medical Evacuation |
Up to $1,000,000 lifetime maximum |
Up to $1,000,000 lifetime maximum |
Return of Minor Children |
Up to $50,000 |
Up to $50,000 |
Repatriation of Remains |
Up to $50,000 |
Up to $50,000 |
Emergency Reunion |
Up to $100,000, subject to a maximum of 15 days |
Up to $100,000, subject to a maximum of 15 days |
Terrorism |
Up to $50,000 lifetime maximum |
Up to $50,000 lifetime maximum |
Political Evacuation |
Up to $100,000 lifetime maximum |
Up to $50,000 lifetime maximum |
Trip Interruption |
Up to $10,000 |
Up to $10,000 |
Hospital Indemnity |
Up to $100 per day for 5 days for inpatient hospitalization |
Up to $100 per day for 5 days for inpatient hospitalization |
Lost Baggage |
Up to $500 |
Up to $1,000 |
Stolen Passport or Visas |
Up to $100 |
Up to $100 |
Personal Liability |
Up to $10,000 lifetime maximum $10,000 third person injury $10,000 third person property $2,500 related third person property |
Up to $10,000 lifetime maximum $10,000 third person injury $10,000 third person property $2,500 related third person property |
Natural Disaster |
Up to $250 a day for 5 days |
Up to $100 a day for 5 days |
Emergency Eye Exam |
Up to $150 ($50 deductible per occurrence) |
Up to $150 ($50 deductible per occurrence) |
Crisis Response Rider |
Up to $100,000 per certificate period, $10,000 for Natural Disaster Evacuation |
Up to $100,000 per certificate period, $10,000 for Natural Disaster Evacuation |
Border Entry Protection |
Up to $500 |
Not Covered |
Optional Add-On Benefits |
- Intercollegiate or Interscholastic Sports Rider up to $20,000.
- Hazardous Activities Rider up to the overall maximum limit.
- Accidental death & dismemberment buy ups up to $100,000.
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- Intercollegiate or Interscholastic Sports Rider up to $20,000.
- Hazardous Activities Rider up to the overall maximum limit.
- Accidental death & dismemberment buy ups up to $100,000.
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