International Health Insurance for International Students

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International Citizens PPO

International Citizens Economy Plan

The IC Economy Insurance is a long-term, annually renewable, US-style major medical insurance plan designed to provide worldwide coverage with a scheduled benefit structure, thus offering lower premiums. The plan provides coverage for:

• Hospitalization/ Surgery
• Intensive Care Treatment
• Outpatient Care
• Evacuation and Repatriation
• Maternity
• Mental Health
• Wellness
• and much more....

PLEASE NOTE - The International Citizens Economy plan is medically underwritten and can take up to 5 business days to be processed by an underwriter. If you would like more information on this please contact us.

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Plan Benefits

Benefits	Limits
Coverage Area	Worldwide
Overall Maximum Limit	$5,000,000 Lifetime
Deductibles Available	$250, $500, $1,000, $2,500 or $5,000 per person per Certificate Period
Coinsurance -- Claims incurred in US or Canada	80% of the next $5,000 of Eligible Medical Expenses after the Deductible, then 100% to the Overall Maximum Limit. The Coinsurance will be waived if expenses are incurred within the PPO
Coinsurance -- Claims incurred outside US or Canada	100% of Eligible Medical Expenses after the Deductible to the Overall Maximum Limit
Acute Onset of Pre-existing Condition	$1,000 during the first Certificate Period and $2,500 during the second Certificate Period
Pre-existing Conditions	$5,000 per Certificate Period subject to a Lifetime Maximum of $50,000 (including Acute Onset claims) after 24 months of continuous coverage hereunder
Maternity	$5,000 per Pregnancy after 12 months of continuous coverage hereunder, including Inpatient, Outpatient and other benefits as herein provided. Not subject to Coinsurance
Newborn care	$15,000 per covered Pregnancy, including Inpatient, Outpatient and other benefits as herein provided, during the first 31 days of life
Organ Transplants	$250,000 Lifetime maximum for covered transplants*
INPATIENT BENEFITS (All Subject to Deductible and Coinsurance)
Hospital Room and Board	$600 per day, maximum of 240 days per Hospitalization (including ICU days)
Intensive Care Unit (ICU)	$1,500 per day, maximum of 240 days per Hospitalization (including non ICU days)
Lab, x-rays and other covered Inpatient services & supplies	Usual, Reasonable and Customary Charges (except as limited herein)
OUTPATIENT BENEFITS (All Subject to Deductible and Coinsurance)
Office Visits (Including Physician, Specialist Physicial, Psychiatrist, Chiropractor, Surgical Consultant, Physical or Occupational Therapist)	25 visits per Certificate Period per person as provided herein
Physician	$70 per visit
Specialist Physician	$70 per visit
Psychiatrist	$60 per visit, after 12 months of continuous coverage hereunder
Chiropractors	$50 per visit (must be prescribed by another non-Chiropractor Physician)
Surgical Consultant	$500 per consultation prior to Surgery
Physical or Occupational Therapy	$50 per visit (must be prescribed by a Physician who is not affiliated with the Physical Therapy practice)
X-rays	$250 per exam (includes Sonograms, Ultrasounds and diagnostic Mammograms)
Laboratory	$300 per exam (includes all procedures carried out on one specimen)
Emergency Room	Usual, Reasonable and Customary
Local Ambulance	$1,500 per Certificate Period per person
INPATIENT or OUTPATIENT BENEFITS (All Subject to Deductible and Coinsurance)
Prescription Medications	Usual, Reasonable and Customary
Surgery	Usual, Reasonable and Customary
Assistant Surgeon	20% of Surgeon benefit
Anesthesiologist	20% of Surgeon benefit
Midwife Services	$500 per covered Pregnancy
MRI, CAT Scan, Echocardiography, Endoscopy, Gastroscopy, Colonoscopy and Cystoscopy	$600 per exam
Chemotherapy and Radiation Therapy	Usual, Reasonable and Customary
WELLNESS BENEFITS (Not Subject to Deductible)
Well Child (under age 19)	$50 per visit for a maximum of 3 visits per Certificate Period (included in Office Visit limit), after 12 months of continuous coverage hereunder
Wellness (Adult 19+)	$250 per Certificate Period, after 24 months of continuous coverage hereunder, including Office Visit for $70 and X-Ray and Lab for $180
OTHER BENEFITS (All Subject to Deductible and Coinsurance)
Durable Medical Equipment	Usual, Reasonable and Customary charges for Wheelchair, Hospital Bed, and/or Toilet
Emergency Medical Evacuation	$50,000 Per Certificate Period
Repatriation of Remains	$25,000 Lifetime Maximum
Emergency Reunion	$5,000 Lifetime Maximum

*Covered transplants include Heart, Heart/Lung, Lung, Kidney, Kidney/Pancreas, Liver and Allogenic and Autologous Bone Marrow.


Optional Term Life Insurance and Accidental Death and Dismemberment

(Not Available to Residents of the US, regardless of your Citizenship)

Term Life Insurance

>> Free Quote/ Apply Online

Plan Exclusions

The following charges, treatments, care, services, supplies and/or conditions are excluded from coverage:

1. Charges not incurred during the Certificate Period
2. Services or treatment payable by another insurance or government
3. Substance abuse
4. Charges which exceed usual, reasonable and customary
5. Investigational or experimental surgeries or treatment
6. Custodial, educational or rehabilitative care
7. Weight modification
8. Cosmetic surgery, unless reconstructive surgery is directly relating to a covered Illness or Injury
9. Individuals HIV+ at effective date
10. Drugs or treatment for sexual dysfunction
11. Charges for use of Emergency Room for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness
12. Drugs or treatment to promote or prevent conception
13. Devices or procedures to correct sight or hearing
14. Self-inflicted Injury or Illness
15. Foot care, unless related to a covered accidental Injury
16. Treatment or supplies not ordered by a Physician or not Medically Necessary, except for Wellness benefits provided herein.
17. Organ transplants, except for covered transplants
18. Speech, acupuncture or sleep therapy
19. Acts of terrorism, war, insurrection, riot or any variation thereof
20. Dental treatment, except emergency treatment following a covered accident, or unless Dental Rider is purchased
21. Orthodontia (Dental Rider Exclusion)
22. Sealants, Bleaching and oral hygiene expenses (Dental Rider Exclusion)

This is a summary of the exclusions contained in the Certificate of Insurance. See the Certificate of Insurance for a complete list of exclusions.

Special Illness Exclusion:
The following conditions which manifest themselves within the first 180 days of coverage are excluded: any condition of the breast, prostate, the reproductive system, hernia, gallstones, kidney stones, glaucoma, cataracts, disk disease, tonsils, adenoids, hemorrhoids, all types of cysts and any disorder or disease of the skin.

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Plan Premiums

	$250 Deductible		$500 Deductible
Age	Male	Female	Male	Female
14 days to 9	$308	$308	$267	$267
10 to 18	$333	$333	$296	$296
19-24	$716	$1,178	$620	$1,082
25-29	$798	$1,315	$697	$1,215
30-34	$847	$1,425	$728	$1,306
35-39	$1,001	$1,642	$810	$1,451
40-44	$1,097	$1,325	$891	$1,118
45-49	$1,222	$1,474	$1,002	$1,254
50-54	$1,493	$1,640	$1,266	$1,413
55-59	$1,804	$1,804	$1,568	$1,568
60-64	$2,656	$2,499	$2,420	$2,264
65-69	$5,545	$4,839	$5,307	$4,602
70	$6,654	$5,806	$6,369	$5,522
71	$6,987	$6,097	$6,687	$5,798
72	$7,336	$6,402	$7,022	$6,088
73	$7,703	$6,722	$7,373	$6,393
74	$8,088	$7,058	$7,741	$6,712

*First two children age 14 days to 9 years are free only when both parents are insured under the Economy Plan. The Dependent Child rate is only available when parent (guardian) is insured under the Economy Plan. Dependent children alone must pay the age 19 to 24 Male rate.

Optional Term Life and AD&D Insurance

AGE	BASIC PREMIUM	SUPPLEMENTAL PREMIUM
19-29	$130	$100
30-39	$210	$160
40-44	$310	$235
45-49	$450	$340
50-54	$570	$430
55-59	$770	$580
60-64	$585	$440
65-69	$315	Not Available
Dependent Child	$85	Not Available

Optional Dental Rider

Citizenship	Premium
US Citizen	$ 348
All Others	$ 492

Optional Sports Rider

14 days - 59 years	$ 250

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Benefits | Exclusions | Premiums | Free Quote | Apply Online

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