Deductible: $100 per Illness/Injury.
$5 co-pay per visit if Treatment received in Student Health Center.
Per Injury/Illness maximum:
For treatment received outside the US and Canada: No coinsurance.
For treatment received within the US and Canada:
In the PPO Network: No coinsurance.
Outside the PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100% up to the policy maximum.
The group member must be a full-time student or scholar at a college or university.
The group member must be residing outside his/her home country for the purpose of pursuing international, educational activities including but not limited to college course work, conducting research or teaching for a temporary period of time.
Must not have obtained residency status in Host Country.
Dependents have to be legal dependents, traveling with the group as a dependent of a group member and traveling outside their home country.
Injury due to accident: Up to $500.
Sudden dental pain: Up to $350.
Per Injury: Up to $350.
Per illness only if admitted In-patient: Up to $350.
Out-patient: $50 per day. $500 lifetime maximum.
In-patient: $10,000 lifetime maximum.
Pre-Existing Condition Coverage: The plan covers all the benefits of pre-existing only after 12 months of continuous coverage.
Emergency Medical Evacuation: Up to $500,000 Lifetime maximum.
Return of Mortal Remains: Up to $50,000.
Political Evacuation: Up to $10,000.
Emergency Reunion: $50,000 maximum.
Intercollegiate/interscholastic/intramural or club sports.
Accidental death & dismemberment.
Home country coverage.
Treatment period: 60 days.
Plan Life: 3 months, can be extended from 12 months to 5 years with no breakage period.
Underwriter: Sirius International Insurance Corporation.