Benefits | Coverage |
Hospital room and board | Average semi-private room rate, including nursing services |
Local ambulance | Up to $500 per injury / illness if hospitalized as inpatient |
Intensive care unit | Up to overall maximum limit |
Outpatient treatment | Up to the overall maximum limit |
Outpatient prescription drugs | 50% of actual charge |
Mental health disorders | Outpatient: Maximum of 30 visits; Inpatient: Maximum 30 days (Treatment must not be obtained at a Student health center) |
Dental treatment due to accident | Up to $250 maximum per tooth; $500 maximum per certificate period |
Emergency dental | Up to $100 for acute onset pain. Not subject to deductible or coinsurance |
Pre-existing condition | 12-month waiting period |
Acute onset of pre-existing condition | $25,000 lifetime maximum for eligible expenses (excludes chronic and congenital conditions) |
Maternity care for a covered pregnancy | Up to $5,000 |
Routine nursery care of newborn | Up to $250 maximum. Not subject to deductible or coinsurance |
Therapeutic termination of pregnancy | Up to $500 maximum per certificate period |
Physical therapy & chiropractic care | Up to $50 per visit per day |
Intercollegiate, interscholastic, intramural, or club sports | Up to $3,000 maximum per injury or illness, medical expenses only |
Terrorism | Up to $50,000 maximum lifetime limit |
Emergency medical evacuation | Up to $250,000 lifetime maximum. Not subject to deductible or coinsurance |
Emergency reunion | Up to $1,000, maximum of 15 days |
Repatriation of remains | Up to $25,000 lifetime maximum (not subject to deductible or coinsurance) |
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