ISI Protect
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.
Economy
- Maximum Benefit per Insured Person per Certificate Period $200,000
- Maximum Benefit per Injury or Illness per Insured Person $100,000
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Eligible Medical Expenses
Deductibles, Co-pays, and Coinsurance All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Deductible $0
- Emergency Room Co-Pay $350
- Physician Office Co-Pay $100
- Student Health Center/UHC-Teladoc Co-Pay $35
- Urgent Care/Walk-in Clinic Co-Pay $75
- Outpatient Prescription Drugs Co-Pay Not subject to Coinsurance $50 Through the Prime Therapeutics Network
- Coinsurance In-network, Inside the US 80% Coverage up to Maximum Benefit
- Coinsurance Out-of-network, inside the US 60% Coverage up to Maximum Benefit
- Coinsurance Outside the US 100% Coverage of Eligible Expenses up to the Maximum Benefit
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Eligible Medical Expenses
Outpatient and Inpatient Services All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Outpatient Facility Charges Usual, reasonable, and customary charges (URC)
- Hospital Room and Board including nursing and Ancillary Services Usual, reasonable, and customary charges (URC)
- Intensive Care Unit Usual, reasonable, and customary charges (URC)
- Operating, treatment, and/or recovery room Usual, reasonable, and customary charges (URC)
- Laboratory Usual, reasonable, and customary charges (URC)
- Radiology/X-Rays Usual, reasonable, and customary charges (URC)
- Professional Fees by Physician including specialists, surgeons, anesthesiologists Usual, reasonable, and customary charges (URC) Assistant surgeon fees subject to a maximum of 20% of covered primary surgeon fees.
- Physical Therapy / Chiropractic Care $25 per visit (Physician treatment plan required; limit of 1 visit per day)
- Maternity Pre-natal, delivery, and post-natal care for a covered pregnancy No Coverage
- Routine Care of a Newborn Per covered pregnancy No Coverage
- Therapeutic Termination of Pregnancy $500 after 90 days of continuous coverage
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Dental Treatment
Accident — $250 per tooth; maximum of $500 (involving associated face, skull, neck and/or jaw Injury)
Acute Onset of Dental Pain — $100 for palliative care only (Certificate Period must be 30 or more days) - Mental Health Disorders Inpatient URC, up to a maximum of $2,500
- Mental Health Disorders Outpatient Coverage includes drug and alcohol abuse $50 per visit; 1 visit per day and 5 total visits
- All other Eligible Medical Expenses Usual, Reasonable, and Customary (URC)
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Eligible Medical Expenses
Features All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Benefit Period 60 days if hospitalized on certificate termination date
- Incidental Trip Home 15 days per 90 days of coverage subject to a maximum of $5,000 if the US is the Home Country
- Pre-Existing Conditions Eligible Medical Expenses No Coverage
- Pre-Existing Conditions Medical Evacuation and Repatriation of Remains No Coverage
- Acute Onset of Pre-Existing Conditions No Coverage
- Wellness Benefit No Coverage
- Terrorism Usual, Reasonable, and Customary Charges (URC)
- COVID-19 including viral mutations Usual, Reasonable, and Customary Charges (URC)
- Eligible Transportation Expenses All covered Eligible Transportation Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
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Local Ambulance
Illness: $500 if admitted as inpatient
Injury: $500 - Interfacility Ambulance Transfer $500
- Emergency Medical Evacuation $50,000
- Emergency Reunion $1,000
- Repatriation of Remains $25,000
- Local Burial/Cremation $5,000 in lieu of Repatriation of Mortal Remains, not subject to Coinsurance
- Natural Disaster No Coverage
- Other Expenses Subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
- Accidental Death & Dismemberment No Coverage
- Personal Liability No Coverage
- School Sports Coverage Injuries sustained while participating in covered School Sports No Coverage
- Adventure Sports Optional Add-On Subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
- Adventure Sports Coverage Injuries sustained while participating in covered Adventure Sport Not Available
Economy Plus
- Maximum Benefit per Insured Person per Certificate Period $500,000
- Maximum Benefit per Injury or Illness per Insured Person $250,000
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Eligible Medical Expenses
Deductibles, Co-pays, and Coinsurance All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Deductible $0
- Emergency Room Co-Pay $250
- Physician Office Co-Pay $75
- Student Health Center/UHC-Teladoc Co-Pay $25
- Urgent Care/Walk-in Clinic Co-Pay $50
- Outpatient Prescription Drugs Co-Pay Not subject to Coinsurance $30 Through the Prime Therapeutics Network
- Coinsurance In-network, Inside the US 80% Coverage up to $50,000; then 100% up to Maximum Benefit
- Coinsurance Out-of-network, inside the US 70% Coverage up to Maximum Benefit
- Coinsurance Outside the US 100% Coverage of Eligible Expenses up to the Maximum Benefit
-
Eligible Medical Expenses
Outpatient and Inpatient Services All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Outpatient Facility Charges Usual, reasonable, and customary charges (URC)
- Hospital Room and Board including nursing and Ancillary Services Usual, reasonable, and customary charges (URC)
- Intensive Care Unit Usual, reasonable, and customary charges (URC)
- Operating, treatment, and/or recovery room Usual, reasonable, and customary charges (URC)
- Laboratory Usual, reasonable, and customary charges (URC)
- Radiology/X-Rays Usual, reasonable, and customary charges (URC)
- Professional Fees by Physician including specialists, surgeons, anesthesiologists Usual, reasonable, and customary charges (URC) Assistant surgeon fees subject to a maximum of 20% of covered primary surgeon fees.
- Physical Therapy / Chiropractic Care $50 per visit (Physician treatment plan required; limit of 1 visit per day)
- Maternity Pre-natal, delivery, and post-natal care for a covered pregnancy $5,000 Lifetime Limit
- Routine Care of a Newborn Per covered pregnancy $250
- Therapeutic Termination of Pregnancy $500 after 90 days of continuous coverage
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Dental Treatment
Accident — $250 per tooth; maximum of $500 (involving associated face, skull, neck and/or jaw Injury)
Acute Onset of Dental Pain — $100 for palliative care only (Certificate Period must be 30 or more days) - Mental Health Disorders Inpatient URC to a maximum of 30 days
- Mental Health Disorders Outpatient Coverage includes drug and alcohol abuse URC to a maximum of 30 visits
- All other Eligible Medical Expenses Usual, Reasonable, and Customary (URC)
-
Eligible Medical Expenses
Features All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Benefit Period 60 days if hospitalized on certificate termination date
- Incidental Trip Home 15 days per 90 days of coverage subject to a maximum of $5,000 if the US is the Home Country
- Pre-Existing Conditions Eligible Medical Expenses Covered after 12 months of continuous coverage
- Pre-Existing Conditions Medical Evacuation and Repatriation of Remains Covered as of Certificate Effective Date
- Acute Onset of Pre-Existing Conditions $5,000 Lifetime Limit
- Wellness Benefit No Coverage
- Terrorism Usual, Reasonable, and Customary Charges (URC)
- COVID-19 including viral mutations Usual, Reasonable, and Customary Charges (URC)
- Eligible Transportation Expenses All covered Eligible Transportation Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
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Local Ambulance
Illness: $750 if admitted as inpatient
Injury: $750 - Interfacility Ambulance Transfer $750
- Emergency Medical Evacuation $250,000
- Emergency Reunion $3,000
- Repatriation of Remains $50,000
- Local Burial/Cremation $5,000 in lieu of Repatriation of Mortal Remains, not subject to Coinsurance
- Natural Disaster No Coverage
- Other Expenses Subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
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Accidental Death & Dismemberment
$25,000 Principal Sum
(Family Maximum: $250,000)
Not subject to Deductible, Co-pays, and Coinsurance - Personal Liability No Coverage
- Adventure Sports Optional Add-On Subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
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Adventure Sports Coverage
Injuries sustained while participating in covered Adventure Sport
Age 15–49: $50,000 Maximum
Age 50–59: $25,000 Maximum
Age 60–64: $10,000 Maximum
Business Class
- Maximum Benefit per Insured Person per Certificate Period $1,000,000
- Maximum Benefit per Injury or Illness per Insured Person $300,000
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Eligible Medical Expenses
Deductibles, Co-pays, and Coinsurance All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Deductible $0
- Emergency Room Co-Pay $150
- Physician Office Co-Pay $50
- Student Health Center/UHC-Teladoc Co-Pay $10
- Urgent Care/Walk-in Clinic Co-Pay $25
- Outpatient Prescription Drugs Co-Pay Not subject to Coinsurance $20 Through the Prime Therapeutics Network
- Coinsurance In-network, Inside the US 80% Coverage up to $25,000, then 100% up to Maximum Benefit
- Coinsurance Out-of-network, inside the US 80% Coverage up to Maximum Benefit
- Coinsurance Outside the US 100% Coverage of Eligible Expenses up to the Maximum Benefit
-
Eligible Medical Expenses
Outpatient and Inpatient Services All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Outpatient Facility Charges Usual, reasonable, and customary charges (URC)
- Hospital Room and Board including nursing and Ancillary Services Usual, reasonable, and customary charges (URC)
- Intensive Care Unit Usual, reasonable, and customary charges (URC)
- Operating, treatment, and/or recovery room Usual, reasonable, and customary charges (URC)
- Laboratory Usual, reasonable, and customary charges (URC)
- Radiology/X-Rays Usual, reasonable, and customary charges (URC)
- Professional Fees by Physician including specialists, surgeons, anesthesiologists Usual, reasonable, and customary charges (URC) Assistant surgeon fees subject to a maximum of 20% of covered primary surgeon fees.
- Physical Therapy / Chiropractic Care $75 per visit (Physician treatment plan required; limit of 1 visit per day)
- Maternity Pre-natal, delivery, and post-natal care for a covered pregnancy $10,000 Lifetime Limit
- Routine Care of a Newborn Per covered pregnancy $500
- Therapeutic Termination of Pregnancy $500 after 90 days of continuous coverage
-
Dental Treatment
Accident — $250 per tooth; maximum of $500 (involving associated face, skull, neck and/or jaw Injury)
Acute Onset of Dental Pain — $100 for palliative care only (Certificate Period must be 30 or more days) - Mental Health Disorders Inpatient URC to a maximum of 30 days
- Mental Health Disorders Outpatient Coverage includes drug and alcohol abuse URC to a maximum of 30 visits
- All other Eligible Medical Expenses Usual, Reasonable, and Customary (URC)
-
Eligible Medical Expenses
Features All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Benefit Period 60 days if hospitalized on certificate termination date
- Incidental Trip Home 15 days per 90 days of coverage subject to a maximum of $5,000 if the US is the Home Country
- Pre-Existing Conditions Eligible Medical Expenses Covered after 12 months of continuous coverage
- Pre-Existing Conditions Medical Evacuation and Repatriation of Remains Covered as of Certificate Effective Date
- Acute Onset of Pre-Existing Conditions $15,000 Lifetime Limit
- Wellness Benefit No Coverage
- Terrorism Usual, Reasonable, and Customary Charges (URC)
- COVID-19 including viral mutations Usual, Reasonable, and Customary Charges (URC)
- Eligible Transportation Expenses All covered Eligible Transportation Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
-
Local Ambulance
Illness: $750 if admitted as inpatient
Injury: $750 - Interfacility Ambulance Transfer $750
- Emergency Medical Evacuation $300,000
- Emergency Reunion $5,000
- Repatriation of Remains $50,000
- Local Burial/Cremation $5,000 in lieu of Repatriation of Mortal Remains, not subject to Coinsurance
- Natural Disaster $100 per day; 7 days maximum
- Other Expenses Subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
-
Accidental Death & Dismemberment
$25,000 Principal Sum
(Family Maximum: $250,000)
Not subject to Deductible, Co-pays, and Coinsurance - Personal Liability No Coverage
- School Sports Coverage Injuries sustained while participating in covered School Sports $5,000 per injury
- Adventure Sports Optional Add-On Subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
-
Adventure Sports Coverage
Injuries sustained while participating in covered Adventure Sport
Age 15–49: $50,000 Maximum
Age 50–59: $25,000 Maximum
Age 60–64: $10,000 Maximum
First Class
- Maximum Benefit per Insured Person per Certificate Period $5,000,000
- Maximum Benefit per Injury or Illness per Insured Person $500,000
-
Eligible Medical Expenses
Deductibles, Co-pays, and Coinsurance All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Deductible $0
- Emergency Room Co-Pay $100
- Physician Office Co-Pay $25
- Student Health Center/UHC-Teladoc Co-Pay $5
- Urgent Care/Walk-in Clinic Co-Pay $10
- Outpatient Prescription Drugs Co-Pay Not subject to Coinsurance $10 Through the Prime Therapeutics Network
- Coinsurance In-network, Inside the US 80% Coverage up to $5,000, then 100% up to Maximum Benefit
- Coinsurance Out-of-network, inside the US 90% Coverage up to Maximum Benefit
- Coinsurance Outside the US 100% Coverage of Eligible Expenses up to the Maximum Benefit
-
Eligible Medical Expenses
Outpatient and Inpatient Services All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Outpatient Facility Charges Usual, reasonable, and customary charges (URC)
- Hospital Room and Board including nursing and Ancillary Services Usual, reasonable, and customary charges (URC)
- Intensive Care Unit Usual, reasonable, and customary charges (URC)
- Operating, treatment, and/or recovery room Usual, reasonable, and customary charges (URC)
- Laboratory Usual, reasonable, and customary charges (URC)
- Radiology/X-Rays Usual, reasonable, and customary charges (URC)
- Professional Fees by Physician including specialists, surgeons, anesthesiologists Usual, reasonable, and customary charges (URC) Assistant surgeon fees subject to a maximum of 20% of covered primary surgeon fees.
- Physical Therapy / Chiropractic Care $100 per visit (Physician treatment plan required; limit of 1 visit per day)
- Maternity Pre-natal, delivery, and post-natal care for a covered pregnancy $15,000 Lifetime Limit
- Routine Care of a Newborn Per covered pregnancy $750
- Therapeutic Termination of Pregnancy $500 after 90 days of continuous coverage
-
Dental Treatment
Accident — $250 per tooth; maximum of $500 (involving associated face, skull, neck and/or jaw Injury)
Acute Onset of Dental Pain — $100 for palliative care only (Certificate Period must be 30 or more days) - Mental Health Disorders Inpatient URC to a maximum of 30 days
- Mental Health Disorders Outpatient Coverage includes drug and alcohol abuse URC to a maximum of 30 visits
- Vaccinations Measles, Mumps, Rubella (MMR), Tetanus/Diphtheria/Pertussis (TDAP), Chicken Pox (Varicella), Hepatitis B and Meningitis (Meningococcal MCV4 and B)
- All other Eligible Medical Expenses Usual, Reasonable, and Customary (URC)
-
Eligible Medical Expenses
Features All covered Eligible Medical Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated. - Benefit Period 60 days if hospitalized on certificate termination date
- Incidental Trip Home 15 days per 90 days of coverage subject to a maximum of $5,000 if the US is the Home Country
- Pre-Existing Conditions Eligible Medical Expenses Covered after 6 months of continuous coverage
- Pre-Existing Conditions Medical Evacuation and Repatriation of Remains Covered as of Certificate Effective Date
- Acute Onset of Pre-Existing Conditions $25,000 Lifetime Limit
- Wellness Benefit $150 for covered immunizations
- Terrorism Usual, Reasonable, and Customary Charges (URC)
- COVID-19 including viral mutations Usual, Reasonable, and Customary Charges (URC)
- Eligible Transportation Expenses All covered Eligible Transportation Expenses are subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
-
Local Ambulance
Illness: $750 if admitted as inpatient
Injury: $750 - Interfacility Ambulance Transfer $750
- Emergency Medical Evacuation $500,000
- Emergency Reunion $5,000
- Repatriation of Remains $50,000
- Local Burial/Cremation $5,000 in lieu of Repatriation of Mortal Remains, not subject to Coinsurance
- Natural Disaster $250 per day; 7 days maximum
- Other Expenses Subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
-
Accidental Death & Dismemberment
$25,000 Principal Sum
(Family Maximum: $250,000)
Not subject to Deductible, Co-pays, and Coinsurance - Personal Liability $200,000 Not subject to Deductible, Co-pays, and Coinsurance
- School Sports Coverage Injuries sustained while participating in covered School Sports $5,000 per injury
- Adventure Sports Optional Add-On Subject to Deductible, Co-pays, and Coinsurance unless otherwise indicated.
-
Adventure Sports Coverage
Injuries sustained while participating in covered Adventure Sport
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.
This plan is underwritten by HDI Global.
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