Medical Maximum |
$200,000 |
$500,000 |
$600,000 |
$5,000,000 |
$50,000, $100,000, $250,000, $500,000 $1,000,000, or $2,000,000 (Ages 70 to 79: $50,000 or $100,000 limit; Ages 80+: $10,000 limit) |
Per Injury/Illness Maximum |
$100,000 |
$250,000 |
$300,000 |
$500,000 |
Benefits up to policy max |
Deductible |
$50 |
$45 |
$35 |
$25 |
$0, $100, $250, $500, $1,000, $2,500 or $5,000 |
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) |
100% coverage on eligible expenses, after the deductible, up to the policy maximum. |
Pre-existing Conditions |
$25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition only |
12-month waiting period
Additional $25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period |
6-month waiting period
Additional $25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period |
6-month waiting period
Additional $25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition during waiting period |
Only charges resulting from an Acute Onset of a Pre-existing Condition can be eligible for coverage. Under Age 70: Covered Up to the Overall Maximum; Ages 70-79: Covered Up to a $100,000 Maximum ($25,000 Lifetime Maximum for Emergency Medical Evacuation) |
Maternity |
Not Covered |
Up to $5,000 |
Up to $10,000 |
Up to $25,000 |
Only treatment for complications of pregnancy during the first 26 weeks of pregnancy can be covered. |
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. |
Not Covered |
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 |
Not Covered |
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 |
Adventure Sports |
Some exclusions apply |
Some exclusions apply |
Some exclusions apply |
Some exclusions apply |
Some exclusions apply |
Emergency Medical Evacuation/Repatriation |
$50,000 / $25,000 |
$250,000 / $25,000 |
$300,000 / $25,000 |
$500,000 / $50,000 |
$1,000,000 / Equal to the elected overall maximum limit |