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International Students Studying In The US Travel Insurance For Student- Benefit Chart

Based on the Primary Applicant
Contact Doug Gulleson at 480-633-9500 or by email

 

Benefits HTH/GeoBlue Navigator SC Liaison Student IMG Student Health Advantage IMG Student Health Advantage Platinum HCC Student Secure Budget & Smart Plan –Student Only HCC Student Secure Elite & Select Plan – Student only
Policy Year Coverage Unlimited

Lifetime

$250,000 (G)

$500,000 (H)

$1,000,000  (I)

$500,000 (student)

$100,000 (dependent)

$1,000,000 (student)

$100,000 (dependent)

$250,000 – Budget

$200,000 – Smart

$500,000 – Elite

$300,000 – Select

Maximum Benefit per Injury or Sickness Unlimited

$250,000(G)

$300,000(H)

$500,000 (I)

$300,000 (student)

$100,000 (dependent)

$500,000 (student)

$100,000 (dependent)

$250,000 – Budget

$100,000 – Smart

To the policy limit
Deductible

Amount Selected

Maximum of $500 for J-1 visa.

$25/per illness/injury in PPO

$50/per illness/injury outside PPO

$100 (Per injury or Sickness) reduced

$25 PPO Provider

$50 non-PPO Provider

$45 (Per injury or Sickness) in PPO or Student Health Center

Otherwise $90

$25 (Per injury or Sickness) in PPO & Student Health Center; otherwise $50
Co-pays

$30 U.S. in-Network

$10 overseas

  $5 co-pay Student Health Center Student Health Center:         $5 co-pay none none
Co-insurance

Co-insurance:

0 – outside USA

20% in-Network in USA

40% out-of-Network in USA

Maximum coinsurance $3000

Plan G: 80% to $10,000, then 100% to plan Maximum (out of your pocket, $2,000)

Plan 2: 100% to plan maximum after deductible (out of your pocket, $0.00)

In PPO & Student Health Center: no coinsurance.

Outside PPO in U.S. 80% to $5000, the 100%

In PPO & Student Health Center: no coinsurance.

Outside PPO in U.S. 80% to $5000, the 100%

Underwriters will pay 80% of
the next $25,000 of Eligible
Expenses after Deductible,
then 100% to Certificate Period Maximum (Budget)

80% of Expenses – Smart

Elite: Charges incurred within the US using PPO network or Student Health Center 100% of eligible expenses, (80% out of PPO)

Select: Charges in PPO network in the US then 80% covered of $5,000, then 100%

Pre-existing Medical Coverage Covered after 12 months Up to $25,000 for Acute Onset Covered after 12 months of continuous coverage Covered after 6 months continuous coverage

12 month waiting period – Budget

$25,000 – unexpected – Smart

6 month waiting period
Maternity coverage As any other illness with maternity rider added in 2cd year

G: 80% to a maximum of $5000 in PPO

H: 80% to $300,000 or $100, 00 if spouse

I: 80% of $500,000 or $100,000 if spouse

none

PPO: 80% of eligible expenses

Out of PPO: 60% of eligible expenses

Newborn care: $750

Budget:

PPO: 80% up to $5,000

Out of PPO: 60% up to $5000

Smart: none

80% up to certificate period maximum within the PPO;

60% up to certificate period maximum outside the PPO

Coverage location

Available in licensed states

Available to students in most states

Anywhere in the US. Throughout the world

Incidental trip home – 2 wks

Anywhere in US and throughout the world

Incidental trip home 2 weeks

Anywhere in the US

 

Incidental Home country coverage 15 days every 3 months, does not accumulate

Anywhere in the US

Incidental Home country coverage 15 days every 3 months, does not accumulate

Medical Facilities, Doctors, and Hospitals to use

Use network facilities in U.S.

(Aetna or BlueCross/Blue Shield depending on the State)

Any in the US

Best to use the PPO network on your card

Any in the US

Best to use the First Health network for PPO

Any in the US

Best to use the First Health network for PPO

Any in the US

Best to use First Health Network

Any in the US

Best to use First Health Network

Accidental Death & Dismemberment $10,000 $25,000 $25,000 $25,000 none $25,000
Medical Evacuation Up to $250,000 Included in maximum $500,000 $500,000

Up to policy limit – Budget

$50,000 – Smart

Up to policy limit
Return of Mortal Remains $25,000 $50,000 $50,000 $50,000 $25,000

$50,000 – Elite

$25,000 – Select

Emergency Reunion $750 $50,000 $50,000 $50,000 $1,000 $5,000
Medical treatment arising from participation in intercollegiate As any other illness $5,000 per Injury/Illness (non-contact sports) $5,000 per Injury/Illness $5,000 per Injury/Illness

$3,000 per Injury / Illness – Budget

None – Smart

$5,000 per Injury / Illness

Outpatient Rx

Rx discount card, reimbursable up to $5000/year

Outpatient:

$10 for Generic $20 for Brand

Inpatient: URC

Outpatient: 50% of actual charges

Inpatient: URC

Outpatient: 50% of actual charges

Outpatient:

50% of actual charges – Budget

None – Smart

Elite: 80% of actual charges

Select: 50% of actual charges

Terrorism Coverage Yes $50,000 $50,000 lifetime $50,000 lifetime $50,000/Budget   Smart: none $50,000
Political Evacuation None $50,000 $10,000 lifetime $10,000 lifetime None None
Universal Rx Pharmacy Discount Savings Yes Yes Yes. Up to 35,000 participating pharmacies in the US Yes. Up to 35,000 participating pharmacies in the US None None

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