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Hospital room and board | ||
Up to average semi-private room rate. | Average semi-private room rate. Includes nursing service | Average semi-private room rate. Includes nursing service |
Prescription Drugs | ||
Company pays 100% after deductible is met 90 day dispensing maximum | Inpatient - After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally Outpatient- 50% of actual charges 90 day dispensing maximum |
Inpatient - After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally Outpatient- 50% of actual charges 90 day dispensing maximum |
Physical Therapy | ||
Company pays 100% after deductible is met, one visit per day | After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally; limit one visit per day | After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally; limit one visit per day |
Waiver of Pre-existing Conditions | ||
For condition existing within 36 months before effective date. After 12 months of continous coverage $500 per period of coverage; $1,500 lifetime maximum. | Charges excluded until after 12 months of continuous coverage | Charges excluded until after 6 months of continuous coverage |
Mental Illness including Alcohol & Substance Abuse | ||
Not covered if incurred in student health center Inpatient: $10,000 maximum limit Outpatient: $50 maximum limit per day.$500 maximum limit |
Outpatient : $50 per day; $500 maximum limit Inpatient : After deductible is met, company pays 80% of expenses out of network(U.S.) or 100% in network(U.S.) and internationally upto $10,000 maximum limit; Student health center treatment :$0 |
Outpatient : $50 per day; $500 maximum limit Inpatient : After deductible is met, company pays 80% of expenses out of network(U.S.) or 100% in network(U.S.) and internationally upto $10,000 maximum limit; Student health center treatment :$0 |
Dental - Sudden Relief of Pain | ||
$350 | $350 | $350 |
Dental - Accident | ||
$500 | $500 | $500 |
Emergency Medical Evacuation & Repatriation | ||
$50,000 lifetime maximum | $500,000 lifetime maximum | $500,000 lifetime maximum |
Emergency Medical Reunion | ||
$15,000 lifetime maximum | $50,000 lifetime maximum | $50,000 lifetime maximum |
Return of Mortal Remains | ||
$25,000 | $50,000 lifetime maximum | $50,000 lifetime maximum |
Political Evacuation & Repatriation | ||
$10,000 | $10,000 | $10,000 |
Terrorism | ||
$50,000 | $50,000 | $50,000 |
Accidental Death and Dismemberment (AD&D) | ||
$25,000 principal sum, Not subject to deductible | $25,000 principal sum, Spouse : $10,000 principal sum; Dependent child : $5,000 principal sum; | $25,000 principal sum, Spouse : $10,000 principal sum; Dependent child : $5,000 principal sum; |
Personal liability | ||
Injury to third party: $2,000 per period of coverage limit after $100 deductible; Damgae to third party's property: $500 per period of coverage limit after $100 deductible | $10,000 combined maximum limit; Injury to third person : subject to a $100 per injury deductible; Damage to third person's property : subject to a $100 per damage deductible; | $10,000 combined maximum limit; Injury to third person : subject to a $100 per injury deductible; Damage to third person's property : subject to a $100 per damage deductible; |