Medical Maximum |
$200,000 |
$500,000 |
$600,000 |
$5,000,000 |
$500,000 |
$1,000,000 |
$5,000,000 |
Per Injury/Illness Maximum |
$100,000 |
$250,000 |
$300,000 |
$500,000 |
$250,000 |
$300,000 |
$500,000 |
Deductible |
$50 |
$45 |
$35 |
$25 |
$0 (co-pays apply) |
$0 (co-pays apply) |
$0 (co-pays apply) |
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: 80% of Eligible Expenses up to $5,000, then 100% up to the Maximum Benefit
Out-Network: 70% of Eligible Expenses up to Maximum Benefit |
In-Network: 80% of Eligible Expenses up to $5,000, then 100% up to the Maximum Benefit
Out-Network: 80% of Eligible Expenses up to Maximum Benefit |
In-Network: 100% of Eligible Expenses up to the Maximum Benefit
Out-Network: 90% of Eligible Expenses up to Maximum Benefit |
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 |
$5,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period |
$15,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period |
$25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period |
Pre-existing Conditions |
Not Covered |
12-month waiting period |
6-month waiting period |
6-month waiting period |
12-month waiting period |
12-month waiting period |
6-month waiting period |
Maternity |
Not Covered |
Up to $5,000 |
Up to $10,000 |
Up to $25,000 |
In Network: Plan pays 80% to $5,000 for a covered pregnancy. Out-of-Network: Plan pays 60% to $5,000 for a covered pregnancy. |
In Network: Plan pays 80% to $10,000 for a covered pregnancy. Out-of-Network: Plan pays 60% to $10,000 for a covered pregnancy. |
In Network: Plan pays 80% to Maximum Benefit for a covered pregnancy. Out-of-Network: Plan pays 60% to Maximum Benefit for a covered pregnancy. |
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. |
Outpatient: Max. 30 days of URC coverage. Inpatient: Max. 30 visits of URC coverage. Coverage includes substance abuse. |
Outpatient: Max. 30 days of URC coverage. Inpatient: Max. 30 visits of URC coverage. Coverage includes substance abuse. |
Outpatient: Max. 30 days of URC coverage. Inpatient: Max. 30 visits of URC coverage. Coverage includes substance abuse. |
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 |
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 |
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. |
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 |
$250,000/ $50,000 |
$300,000/ $50,000 |
$500,000/ $50,000 |