Student Health Advantage Platinum Benefits

Maximum Limits

Student: $1,000,000 Dependent: $100,000

Deductible- Outside U.S.

$100 per illness/injury

Deductible- Inside U.S.

PPO Provider: $100 per illness/injury

 

NON PPO Provider: $150 per illness/injury

Coinsurance Outside the U.S.

 No coinsurance

In U.S.

In PPO: No Coinsurance

 

Out of PPO: 80% of eligible medical expenses up to $5,000 then 100% thereafter

Hospital Room & Board

Average semi-private room rate, including nursing service

Intensive Care

After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.)

Maternity and Newborn Care

$5,000 max limit. Benefit includes newborn routine care during the first 31 days of life

After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.)

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 with In-patient admission

After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally

Emergency Room without In-patient 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 additional $250 Deductible

Mental & Nervous Disorders

Out-Patient: $50 per day; $500 lifetime maximum

 

In-Patient: After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally to $10,000 lifetime maximum

Prescription Drugs

In-Patient: After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally Out-Patient: 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 once per day

Local Ambulance

Up to $750 per illness resulting in hospitalization or injury.

Dental

Injury due to covered Accident: $500

 

Sudden & Unexpected Pain to natural teeth: $350

Eligible Medical Expenses

After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally

Emergency Medical Evacuation

$500,000 lifetime maximum

Emergency Reunion

$50,000 lifetime maximum

Return of Mortal Remains

$50,000 lifetime maximum

Intercollegiate/Interscholastic/Intramural or Club Sports

$5,000 maximum per injury/illness

Pre-Existing Conditions

Charges excluded after 6 months of continuous coverage

 

 

*Terms and Conditions of the contract do apply