International Student Insurance

Deductible (out-of-pocket expense per visit/incident)

• $25 deductible for Elite within PPO per illness/injury, or using the Student Health Center at your campus or outside the USA (Otherwise, $50 per incident)
• $35 deductible for Select within PPO per illness/injury, or using the Student Health Center at your campus or outside the USA (Otherwise, $50 per incident)
• $45 deductible for Budget within PPO per illness/injury, or using the Student Health Center at your campus or outside the USA (Otherwise, $90 per incident)
• $50 deductible for Smart within PPO per illness/injury, or using the Student Health Center at your campus or outside the USA (Otherwise, $100 per incident)

Coinsurance (The amount you pay per year besides premiums and deductible)

• Elite: Underwriters pay 100% of eligible expenses after the deductible to the overall maximum limit.
• Select: Underwriters will pay 80% of the next $5,000 of eligible expenses after deductible, then 100% to certificate period maximum.
• Budget: Underwriters will pay 80% of the next $25,000 of eligible expenses after deductible, then 100% to certificate period maximum
• Smart: Underwriters will pay 80% of eligible expenses after the deductible is met
• Local ambulance – Up to $750 (Elite & Select) up to $500 (Budget), up to $300 (Smart) per incident if hospitalized as inpatient
• Intensive Care Unit – Usual, reasonable and customary
• Outpatient treatment – Usual, reasonable and customary

• Prescription drugs:

Elite: Generic Drugs – 100% coinsurance; Brand Name Drugs – 50% coinsurance; Specialty Drugs – No coverage
Select, Budget & Smart: 50% of actual charges – not subject to deductible or coinsurance

• Emergency Medical Evacuation is covered, Repatriation of Remains is covered, (as is AD&D on Select plan)
• Dental emergency and Dental Treatment to alleviate pain (on Select)
• Mental health/Counseling, incl. alcoholism drug abuse
• Pre-existing conditions
  • Elite: 180-day waiting period
  • Select: 180-day waiting period
  • Basic: 360-day waiting period
  • Smart: Pre-existing conditions are excluded. $25,000 lifetime maximum for eligible medical expenses for the acute onset of pre-existing condition only (see below).

• ACUTE ONSET OF PRE-EXISTING CONDITION ARE COVERED IF:

1. Charges for a sudden and unexpected outbreak or recurrence of a pre-existing condition(s) which:
a. Occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms; and
b. Is of short duration; and
c. Is rapidly progressive; and
d. Requires urgent care.

YOU ARE NOT COVERED unless you fulfill the following condition:
1. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

YOU ARE NOT COVERED IF:

1. The Acute Onset of a Pre-existing Condition(s) occurs before the certificate effective date. Or
2. The pre-existing condition is a chronic or congenital condition or that gradually becomes worse over time. Or
3. Charges are for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the certificate effective date. Or
4. Expenses arise directly or indirectly from anything in the General Exclusions.

See brochure for complete list of benefits