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.
| 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 |
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| 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) |
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| 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 |
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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 Lloyd's.