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
See policy wording for full benefit description |
12-month waiting period
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 |
6-month waiting period
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 |
6-month waiting period
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 |
Only charges resulting from an Acute Onset of a Pre-existing Condition can be eligible for coverage. Coverage is for those under age 80 and is up to the policy maximum of the plan. For Emergency Medical Evacuation, an Acute Onset of a Pre-existing Condition is covered up to a $25,000 lifetime maximum.
See policy wording for full benefit description |
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 |