Study USA Basic
Plan maximum:
$100,000
Deductible
|
Study USA Standard
Plan maximum:
$100,000
Deductible
|
Study USA Preferred
Plan maximum:
$300,000
Deductible
|
Study USA Platinum
Plan maximum:
$500,000
Deductible
|
---|---|---|---|
COVID-19 Coverage | |||
No Coverage | Covered as any other illness | Covered as any other illness | Covered as any other illness |
Pre-existing Conditions Waiting Period | |||
No Coverage | $500 maximum per certificate period; 12 months waiting period | 12 months waiting period | 6 months waiting period |
Maximum per injury or illness | |||
$100,000 | $100,000 | $300,000 | $500,000 |
Overall Maximum Limit | |||
$200,000 | $200,000 | $600,000 | $3,000,000 |
Deductible (except emergency room) | |||
$250 in network / $500 out of network | $100 in network / $250 out of network | $50 in network / $150 out of network | $25 in network / $100 out of network |
ER Deductible | |||
$500 per incident | $350 per incident | $250 per incident | $100 per incident |
Coinsurance inside the U.S. | |||
In network: 80% after deductible, up to overall maximum limit Out of Network: Plan pays 100% |
In network: 80% after deductible, up to $25,000, then overall maximum limit Out of Network: Plan pays 100% |
In network: 80% after deductible, up to $25,000, then overall maximum limit Out of Network: Plan pays 100% |
In network: 80% after deductible, up to $25,000, then overall maximum limit Out of Network: Plan pays 100% |
Coinsurance outside the U.S. | |||
Plan pays 100% | Plan pays 100% | Plan pays 100% | Plan pays 100% |
Local Ambulance | |||
$300 per injury or illness | $350 per injury or illness | $350 per injury or illness | $350 per injury or illness |
Prescription Drugs | |||
For outpatient prescription 50% of actual charges | $30 deductible for generic drugs $100 deductible for brand name |
$15 deductible for generic drugs $50 deductible for brand name |
$15 deductible for generic drugs $30 deductible for brand name |
Wellness | |||
Not Avaliable | 100% of one routine physical exam per member | 100% of one routine physical exam per member | 100% of one routine physical exam per member |
Dental Treatment due to Accident | |||
Not Available | Not Available | $1,000 maximum per certificate period | $1,000 maximum per certificate period |
Dental Treatment due to Alleviate pain | |||
Not Available | Not Available | $100 | $100 |
Intercollegiate Interscholastic, Intramural or club sports | |||
Not Available | Not Available | Not Available | Optional Buy-Up: $10,000 |
Mental Health Disorders | |||
Outpatient $50 max per day, $500 max; Inpatient Up to $5,000 (excludes drug and alcohol abuse). No treatment at student health center |
Outpatient $50 max per day, $500 max; Inpatient Up to $5,000 (excludes drug and alcohol abuse). No treatment at student health center |
Outpatient $50 max per day, $500 max; Inpatient Up to $10,000 (includes drug and alcohol abuse). No treatment at student health center |
Within PPO 80% of eligible expenses; Outside PPO up to overall maximum limit Outside U.S. 100% coinsurance No treatment at student health center (includes drug and alcohol abuse). |
Maternity care for covered pregnancy | |||
Not Avaliable | IN PPO NETWORK: 80% of eligible expenses; OUT OF PPO NETWORK: Up to the overall maximum. Outside US: 100% coinsurance up to overall maximum |
IN PPO NETWORK: 80% of eligible expenses; OUT OF PPO NETWORK: Up to the overall maximum. Outside US: 100% coinsurance up to overall maximum |
IN PPO NETWORK: 80% of eligible expenses; OUT OF PPO NETWORK: Up to the overall maximum. Outside US: 100% coinsurance up to overall maximum |
Repatriation of Remains | |||
$25,000 lifetime maximum | $25,000 lifetime maximum | $25,000 lifetime maximum | $50,000 lifetime maximum |
Terrorism | |||
Not Avaliable | Not Avaliable | Up to $50,000 lifetime maximum | Up to $50,000 lifetime maximum |
Accidental Death and Dismemberment | |||
Not Avaliable | Up to $5,000 lifetime maximum | Up to $25,000 lifetime maximum | Up to $25,000 lifetime maximum |
Emergency Reunion | |||
Up to $1,500, maximum of 15 days | Up to $2,500, maximum of 15 days | Up to $2,500, maximum of 15 days | Up to $5,000, maximum of 15 days |
Emergency Medical Evacuation | |||
$50,000 lifetime maximum | $250,000 lifetime maximum | $500,000 lifetime maximum | $500,000 lifetime maximum |
Personal Liability | |||
Not Available | Not Available | Not Available | Up to $150,000 lifetime maximum Up to $150,000 third person injury Up to $150,000 third person property $1,500 related third person property - not subject to deductible, coinsurance, or overall maximum limit |