Medical Maximum |
$200,000 |
$500,000 |
$600,000 |
$5,000,000 |
$5,000,000 |
Per Injury/Illness Maximum |
$100,000 |
$250,000 |
$300,000 |
$500,000 |
Choice of $50,000, $100,000, $250,000, or $500,000 |
Deductible |
$50 |
$45 |
$35 |
$25 |
Choice of $0, $100, $250, $500 per illness or injury |
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) |
USA In-Network: Plan pays 90%; $1000 out-of-pocket maximum USA Out-of-Network: Plan pays 80%; 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 |
Pre-existing Conditions |
Not Covered |
12-month waiting period |
6-month waiting period |
6-month waiting period |
$500 per period of coverage, $1,500 maximum limit
Available after 12 months of continuous coverage |
Maternity |
Not Covered |
Up to $5,000 |
Up to $10,000 |
Up to $25,000 |
Not 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. |
Outpatient: $50 maximum per day; $500 maximum limit
Inpatient: $10,000 maximum limit
Not covered if incurred in 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 |
No Coverage
Optional Team Sports Add-on available, please select that option to view pricing. |
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 |
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 |
$50,000/$25,000 |