Maximum benefits per injury/illness: $300,000 (participant) $50,000 (spouse) $50,000 (child)
Deductible: $25 per injury or illness within the PPO outside the U.S. or student health center; otherwise $50 per injury or illness
Claims incurred inside US or Canada:
Underwriters will pay 80% of the next $5,000 of eligible expenses after deductible, then 100% to certi?cate period maximum.
For charges incurred within the PPO or at a Student Health Center, coinsurance will be waived
Claims incurred outside US or Canada: After the Deductible, Underwriters will pay 100% of Eligible Expenses to Certi?cate Period Maximum
Pre-Existing Condition Coverage: 180-day waiting period
Due to accident: $250 maximum per tooth $500 maximum per certificate period.
Sudden Pain: $100 maximum per certi?cate period
Outpatient or inpatient: 80% within the PPO, 60% out of network. Maximum 30 days of coverage. Coverage includes drug abuse or alcohol abuse.
Treatment must not be obtained at a student health center
Other Emergency Care:
Emergency Medical Evacuation - $300,000 Lifetime benefit.
Repatriation of Remains - $25,000.
Emergency Reunion - $5,000.
Physical therapy - $50 maximum per visit per day.
Therapeutic termination of pregnancy - $500 maximum per certificate period.
Terrorism - $50,000 maximum lifetime limit.
Local ambulance - Up to $750 per injury / illness if hospitalized as inpatient.
Intercollegiate, interscholastic, intramural, or club sports - $5,000 maximum per injury / illness medical expenses only
Underwriter: Underwritten by Sirius International Insurance Corporation, a Lloyd's, London.