Medical Maximum |
$200,000 |
$500,000 |
$600,000 |
$5,000,000 |
$500,000 |
$1,000,000 |
Per Injury/Illness Maximum |
$100,000 |
$250,000 |
$300,000 |
$500,000 |
$300,000 |
$500,000 |
Deductible |
$50 |
$45 |
$35 |
$25 |
$100 |
$25 |
Coinsurance |
In-Network: 80% of eligible expenses after the deductible up to the overall maximum
Out-Network: Usual, Reasonable, and Customary (URC) |
In-Network: 80% of the next $25,000 of eligible expenses after the deductible, then 100% to the overall maximum
Out-Network: Usual, Reasonable, and Customary (URC) |
In-Network: 80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum
Out-Network: Usual, Reasonable, and Customary (URC) |
In-Network: 100% of eligible expenses after the deductible to the overall maximum
Out-Network: Usual, Reasonable, and Customary (URC) |
In-Network: The plan pays 100% of eligible expenses up to Maximum Limit Out-Network:The plan pays 80% of eligible expenses up to $5,000, then 100% up to Maximum Limit |
In-Network: 100% of eligible expenses up to Maximum Limit Out-Network: 80% up to $5,000, then 100% up to Maximum Limit |
Pre-existing Conditions (Acute Onset) |
$25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition only
See policy wording for full benefit description |
Additional $25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period
See policy wording for full benefit description |
Additional $25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period
See policy wording for full benefit description |
Additional $25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period
See policy wording for full benefit description |
Not Covered |
Not Covered |
Pre-existing Conditions |
Not Covered |
12-month waiting period |
6-month waiting period |
6-month waiting period |
After 12 months of continuous coverage |
After 6 months of continuous coverage |
Maternity |
Not Covered |
Up to $5,000 |
Up to $10,000 |
Up to $25,000 |
Not Covered |
Up to $5,000 |
Mental Health |
Outpatient: $50 per day, $500 Inpatient: Up to $5,000 |
Outpatient: Max. 30 days of coverage. Inpatient: Max. 30 visits. Coverage includes drug and alcohol abuse. |
Outpatient: Max. 30 days of coverage. Inpatient: Max. 30 visits. Coverage includes drug and alcohol abuse. |
Outpatient: Max. 30 days of coverage. Inpatient: Max. 30 visits. Coverage includes drug and alcohol abuse. |
Inpatient Treatment:$10,000 Lifetime Maximum Outpatient Treatment: $50 per day; $500 Lifetime Maximum. *Not Eligible for coverage within a Student Health Center |
Inpatient Treatment:$10,000 Lifetime Maximum Outpatient Treatment: $50 per day; $500 Lifetime Maximum. *Not Eligible for coverage within a Student Health Center |
School Team Sports |
Not Covered |
No Coverage
Optional Team Sports rider available, please select that option to view pricing |
No Coverage
Optional Team Sports rider available, please select that option to view pricing |
No Coverage
Optional Team Sports rider available, please select that option to view pricing |
Coverage up to $5,000 coverage per injury / illness — medical expenses only for intercollegiate, interscholastic, intramural, or club sports |
Coverage up to $5,000 coverage per injury / illness — medical expenses only for intercollegiate, interscholastic, intramural, or club sports |
Recreational, Fitness and Leisure Activities |
Covered per policy conditions |
Covered per policy conditions |
Covered per policy conditions |
Covered per policy conditions |
Covered per policy conditions |
Covered per policy conditions |
Adventure Sports |
Some exclusions apply |
Some exclusions apply |
Some exclusions apply |
Some exclusions apply |
No Coverage
Optional Adventure Sports rider available, please select that option to view pricing. |
No Coverage
Optional Adventure Sports rider available, please select that option to view pricing. |
Emergency Medical Evacuation/Repatriation |
$50,000 / $25,000 |
$250,000 / $25,000 |
$300,000 / $50,000 |
$500,000 / $50,000 |
$500,000 / $50,000 |
$500,000 / $50,000 |