You are eligible for the plan if you are traveling outside of your home country and inside the United States as a full time international student or full time scholar and at least 12 years old and under 65 years old.Inside the US, you are automatically eligible for this plan with a valid F1 status, OPT Status, M-1 Status, or J1 status. For other types of visas, you must be enrolled as a full time international student at a secondary school, college, or university.
A pre-existing condition is any:
The ISI Protect does not cover routine vision or dental services, however, it does offer limited coverage for dental accidents and emergency dental treatment for unexpected pain. Please see the plan benefits page for full details.
After any co-pays, you may then need to pay coinsurance, which is a percentage you will have to pay out of pocket for your eligible medical expenses and the percentage the insurance company will pay. For example, if the coinsurance of the plan includes 80% coverage, the insurance plan will pay 80%, and you will need to pay the remaining 20%.Inside the USA
The coinsurance of this plan is as follows:
What does Usual, Reasonable and Customary (URC) mean? URC — which stands for Usual Reasonable and Customary — is a typical and reasonable amount of expenses for similar services, medicines or supplies within the area in which the charge is incurred, so long as those expenses are reasonable.
What is defined as Usual, Reasonable and Customary charge following factors, without limitation: the amount charged by the provider, the amount charged by similar providers or providers in the same or similar locality,the amount paid by other payors for the same or comparable services, medicines or supplies in the same or similar locality, whether the services or supplies were unbundled or should have been included in the allowance of another service, the amount charged by the providers for the same or comparable services,medicines or supplies in other parts of the country, the cost to the provider of providing the service, medicine or supply,the level of skill,extent of training,and experience required to perform the procedure or service, the length of time required to perform the procedure or services as compared to the length of time required to perform other similar services;the length of time required to perform the procedure or services as compared to national standards and/or benchmarks, the severity or nature of the Illness orInjury being treated, and such other factors as Underwriters, in the reasonable exercise of discretion, determine are appropriate.
For example, if a particular procedure costs $5,000 on average in New York City, the insurance company will not pay your provider in New York City $10,000 for the same exact procedure. Instead, they will limit their payment to "Usual Reasonable and Customary" — in this example, $5,000. If you go inside the MultiPlan Network or the UnitedHealthCare Network, these rates are already negotiated and within the URC.
Yes, the plan provides the following home country coverage options:Incidental Home Country Coverage
For every three months of coverage, the ISI Protect will provide you with 15 days of medical expense coverage for incidental trips back to your Home Country. Return to your Home Country must not be taken for the purpose of obtaining treatment of an Illness or Injury that began while traveling, and you must return to your host country to be eligible for this benefit. If the Insured Person remains in the individual’s Home Country for more than fourteen (15) days during an Incidental Trip Home, all coverage, including coverage of Eligible Medical Expenses, automatically terminates at 11:59pm Local Standard Time (location of Insured Person) on the 15th day.Benefit Period Medical Coverage A Benefit Period begins on the first day you receive a diagnosis or treatment of a covered Illness or Injury while outside your Home Country and lasts for 60 days. If you started a Benefit Period while this insurance was in effect, you are covered only for Medical expenses for the duration of the Benefit Period, regardless of whether you are at home or abroad.
You are free to visit any provider you wish with the ISI Protect plan; however, the plan does have an optional Preferred Provider Organization in the USA. By going to an in-network provider, you will have less out of pocket expenses and in-network will typically be able to direct bill the insurance company so you won’t have to pay for the services up front at the time of treatment. Direct billing is always up to the provider, so we suggest calling the provider before seeking treatment to be sure.
Claims are paid depending on where you are located and where you seek treatment:In-network while inside the USA
When you visit a provider that is part of the Preferred Provider Organization, your insurance bill is typically paid directly. You will need to complete a claim form and email this to Point Comfort for processing.Out-of-network while inside the USA
When you visit a provider that is outside the network, you will need to pay for all services up front and then submit your bills and receipts, along with a claim form for reimbursement to Point Comfort.
This plan is underwritten by HDI Global.