Benefits | Coverage |
Hospital room and board | Average semi-private room rate, including nursing services. |
Local ambulance | Up to $300 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:$50 maximum per day, $500 maximum; Inpatient: Up to $5,000 maximum (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. |
Dental treatment to alleviate pain | Up to $100 for acute onset pain. Not subject to deductible or coinsurance. |
Acute onset of pre-existing condition | $25,000 lifetime maximum for eligible expenses (excludes chronic and congenital conditions) |
Therapeutic termination of pregnancy | Up to $500 maximum per certificate period |
Physical therapy & chiropractic care | Up to $25 per visit per day |
Emergency medical evacuation | Up to $50,000 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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