ISI Protect Insurance | Benefits

The ISI Protect is designed for international students studying inside the US, and is available in four levels: Economy, Economy Plus, Business Class, and First Class. Each plan level offers different coverage limits with the Economy plan being the most affordable and the First Class plan being the most comprehensive. Please view the benefits below and contact us if you need further help with choosing the best plan option for you.


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Benefits Economy Economy Plus Business Class First Class
Certificate Period Maximum $200,000$200k $500,000$500k $1,000,000$1M $5,000,000$5M
Maximum Benefit per illness/Injury $100,000$100k $250,000$250k $300,000$300k $500,000$500k
Deductible $0
ER Co-Pay $350 $250 $150 $100
Student Health Center/Teladoc Co-Pay $35 $25 $10 $5
Physician office Co-Pay $100 $75 $50 $25
Urgent Care/Walk-in Clinic Co-Pay $75 $50 $25 $10
Provider Network Doctor/Hospital Search
Coinsurance
In-network, Inside the US
80% Coverage up to Maximum Benefit 80% Coverage up to $5,000, then 100% up to Maximum Benefit 100% Coverage up to Maximum Benefit
Coinsurance
Out-of-network, inside the US
60% Coverage up to Maximum Benefit 70% Coverage up to Maximum Benefit 80% Coverage up to Maximum Benefit 90% Coverage up to Maximum Benefit
Coinsurance
Outside the US
100% of Eligible Expenses
The following benefits are all subject to the deductible, copays, and coinsurance, unless otherwise stated:
Hospital Room & Board Usual, reasonable, and customary charges
Local Ambulance Illness: $500 if admitted as inpatient
Injury: $500
Illness: $750 if admitted as inpatient
Injury: $750
Intensive Care Unit Usual, reasonable, and customary charges
Outpatient Treatment Usual, reasonable, and customary charges
Outpatient Prescription Medication
Not subject to Coinsurance
$50 Co-Pay $30 Co-Pay $20 Co-Pay $10 Co-Pay
Through the Magellan Rx Network
COVID-19
including viral mutations
Usual, reasonable, and customary charges
Incidental Trip Home 15 days per 90 days of coverage
Radiology / X-rays / Labortory Usual, reasonable, and customary charges
Professional fees by Physician
including specialists, surgeons, anesthesiologists
Usual, reasonable, and customary charges
assistant surgeon fees subject to a maximum of 20% of covered primary surgeon fees
Operating room, treatment room and/or recovery room Usual, reasonable, and customary charges
Interfacility Ambulance Transfer $500 $750
Wellness Benefit No Coverage $150 for covered immunizations
Mental Health
Outpatient
Coverage includes drug and alcohol abuse
Up to $50 per day; 5 visits maximum Usual, reasonable and customary charges; 30 visits maximum
Mental Health
Inpatient
Up to $2,500 maximum Usual, reasonable and customary charges; 30 days maximum
Dental Treatment Accident — $250 per tooth; maximum of $500
Acute Onset of Dental Pain — $100 for palliative care only (Certificate Period must be 30 or more days)
Pre-existing Condition No Coverage 6-month waiting period 3-month waiting period
Acute Onset of Pre-existing Condition No Coverage $5,000 $15,000 $25,000
Maternity
Pre-natal, delivery, and post-natal care for a covered pregnancy
No Coverage In Network: Plan pays 80% to $5,000 Out-of-Network: Plan pays 60% to $5,000 In Network: Plan pays 80% to $10,000 Out-of-Network: Plan pays 60% to $10,000 In Network: Plan pays 80% to Maximum Benefit Out-of-Network: Plan pays 60% to Maximum Benefit
Newborn Care No Coverage $250 per covered Pregnancy $500 per covered Pregnancy $750 per covered Pregnancy
Therapeutic Termination of Pregnancy $500 after 90 days of continuous coverage
Sports Coverage
Interscholastic, Intramural, Intercollegiate, Club Sports
Not Available $5,000 per Injury
Outpatient Physical Therapy & Chiropractic Care
Subject to coinsurance
$75 Co-Pay $50 Co-Pay $25 Co-Pay $10 Co-Pay
Terrorism Usual, reasonable, and customary charges
Emergency Medical Evacuation $50,000$50k $250,000$250k $300,000$300k $500,000$500k
Emergency Reunion $1,000 $3,000 $5,000
Accidental Death & Dismemberment No Coverage $25,000
Repatriation of Remains $25,000$25k $50,000$50k
All other Eligible Medical Expenses Usual, reasonable, and customary charges
Natural Disaster No Coverage $100 per day; 7 days maximum $250 per day; 7 days maximum
Personal Liability No Coverage $200,000
Adventure Sports Add-On:
Adventure Sports Coverage Not Available Age 15-49: $50,000 Maximum
Age 50-59: $25,000 Maximum
Age 60-64: $10,000 Maximum
Please note: The benefit table listed above is a consolidated version of the full plan benefits. Please view the plan certificate for the full benefits and limitations of the plan. Limits apply to all benefits.

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This plan is underwritten by Lloyd's.


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