| Benefits |
Coverage |
| Hospital room and board |
Average semi-private room rate. Includes nursing service
|
| Intensive care |
After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally |
| Emergency room injury |
After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally |
| Emergency room illness resulting in hospitalization |
After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally |
| Emergency room illness - without inpatient admission |
After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally; Subject to additonal $250 deductible |
| Mental & nervous disorders and substance abuse |
Outpatient - $50 per day; $500 lifetime maximum Inpatient: After deductible is met, company pays 80% of expenses out-of-network(U.S.) or 100% in-network(U.S.) and internationally up to $10,000 maximum limit;
Student health center treatment - $0 |
| Prescription drugs |
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 |
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 |
| Emergency dental treatment |
Injury due to accident: $500 maximum per accident
Sudden & unexpected pain to natural teeth - $350 maximum |
| Emergency medical evacuation |
$500,000 lifetime maximum |
| Emergency reunion |
$50,000 lifetime maximum |
| Return of mortal remains |
$50,000 maximum |
| Political evacuation and repatriation |
$10,000 lifetime maximum |
| Intercollegiate/interscholastic/intramural or club sports |
$5,000 maximum per injury or illness |
| Incidental trip coverage |
Up to a cumulative 14 days(available for non-U.S. residents only) |
| Terrorism |
$50,000 lifetime maximum |
| Personal Liability |
$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
|
| Accidental death & dismemberment |
Student - $25,000 principal sum
Spouse - $10,000 principal sum
Dependent child - $5,000 principal sum
Accidental dismemberment percentage of principal sum |
Student Health Advantage insurance Eligibility
Student Health Advantage Renewal/Extension
