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Student Secure Benefits
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Maximum Limit
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Elite
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$500,000 Certificate Maximum
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$500,000 per Illness or Injury
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Select
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$300,000 Certificate Maximum
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$300,000 per Illness or Injury
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Budget
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$250,000 Certificate Maximum
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$250,000 per Illness or Injury
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Smart
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$200,000 Certificate Maximum
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$100,000 per Illness or Injury
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Deductibles- per Injury or Illness
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Elite & Select
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Outside of U.S.: $25
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Inside U.S.: Student Health Center or PPO: $25 Outside of PPO:$50
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Budget
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Outside of U.S.: $45
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Inside of U.S.: Student Health Center or PPO: $45 Outside PPO: $90
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Smart
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Outside of U.S.: $50
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Inside of U.S.: Student Health Center or PPO: $50 Outside PPO: $100
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Emergency Room Deductible- Claims incurred in the U.S.
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Elite & Select
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$100
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Budget
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$350
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Smart
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$350
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Coinsurance Outside U.S.
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Underwriters will pay 100% of Eligible Medical Expenses after Deductible up to the Certificate Period Maximum
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Coinsurance- Inside the U.S.
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Elite
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PPO: 100% of Eligible Expenses after the Deductible to the Certificate Period Maximum
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NON PPO: 80% of the next $5,000 of Eligible Expenses after the Deductible, then 100% to the Certificate Period Maximum
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Select
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80% of the next $5,000 of Eligible Expenses after the Deductible, then 100% to the Certificate Period Maximum
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Budget
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80% of the next $25,000 of Eligible Expenses after the Deductible, then 100% to the Certificate Period Maximum
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Smart
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80% of Eligible Expenses after the Deductible up to the Certificate Period Maximum
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Hospital Pre-Certification Penalty
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50% of Eligible Medical Expenses
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Hospital Room & Board
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Average Semi-private room rate, including nursing services
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Intensive Care Unite
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URC
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Local Ambulance
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Elite & Select
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$750 per Injury or Illness when covered injury or illness results in Inpatient hospitalization.
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Budget
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$500 per Injury or Illness when covered injury or illness results in Inpatient hospitalization.
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Smart
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$300 per Injury or Illness when covered injury or illness results in Inpatient hospitalization.
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Outpatient Treatment
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URC
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Outpatient Prescription Drugs
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Elite
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80% of Actual charges
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Select, Budget & Smart
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50% of Actual Charges
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Mental Health Disorders
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Outpatient
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Inpatient
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Elite & Select (includes Drug Abuse and Alcohol Abuse)
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After Deductible, Eligible Expenses will be paid at 80% up to the Certificate Period Maximum within the PPO or 60% NON PPO for a maximum of 30 visits per Certificate Period
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After Deductible, Eligible Expenses will be paid at 80% up to the Certificate Period Maximum within the PPO or 60% for NON PPO for a maximum of 30 days per Certificate Period. Treatment must not be provided at a Student Health Center
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Budget (includes Drug Abuse and Alcohol Abuse)
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$50 Maximum per day, $500 Maximum per certificate
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URC up to $10,000 Maximum per Certificate Period. Treatment must not be provided at a Student Health Center
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Smart
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$50 Maximum per day, $500 Maximum per certificate
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URC up to $5,000 Maximum per Certificate Period. Treatment must not be provided at a Student Health Center
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Acute onset of Pre-Existing Condition
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Smart only (Excludes chronic and congenital conditions)
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After deductible and coinsurance, $25,000 Lifetime maximum for Eligible Medical Expenses
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Maternity Care for a Covered Pregnancy
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Elite & Select
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After Deductible, Eligible Expenses will be paid at 80% within the PPO or 60% NON PPO
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Budget
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After Deductible, Eligible Expenses will be paid at 80% within the PPO or 60% NON PPO up to Certificate Period Maximum of $5,000
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Smart
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No Coverage
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Nursery Care of Newborn
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Elite & Select
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$750 Maximum Certificate Period
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Budget
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$250 Maximum Certificate Period
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Smart
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No Coverage
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Physical Therapy & Chiropractic Care
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Elite
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Maximum $75 per visit per day. Must be ordered in advance by a Physician and not obtained at a Student Health Center
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Select & Budget
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Maximum $50 per visit per day. Must be ordered in advance by a Physician and not obtained at a Student Health Center
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Smart
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Maximum $25 per visit per day. Must be ordered in advance by a Physician and not obtained at a Student Health Center
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Intercollegiate, interscholastic, intramural, or club sports
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Elite & Select
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$5,000 Maximum per Injury or Illness. Medical expenses only
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Budget
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$3,000 Maximum per Injury or Illness. Medical expenses only.
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Smart
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No Coverage
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Dental Treatment
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Due to Accident
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To Alleviate Pain
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Elite, Select & Budget
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$250 per tooth; $500 Maximum per Certificate Period
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$100 Maximum per Certificate Period (not subject to Deductible or Coinsurance)
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Smart
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No Coverage
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No Coverage
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Emergency Medical Evacuation
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Elite
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Not Subject to Deductible or Coinsurance $500,000
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Select
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Not Subject to Deductible or Coinsurance $300,000
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Budget
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Not Subject to Deductible or Coinsurance $250,000
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Smart
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Not Subject to Deductible or Coinsurance $50,000
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Repatriation of Remains
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Elite
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$50,000 Maximum (not subject to Deductible or Coinsurance)
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Select, Budget & Smart
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$25,000 Maximum (not subject to Deductible or Coinsurance)
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Emergency Reunion
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Elite & Select
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$5,000 Lifetime Maximum (subject to a maximum of 15 days, not subject to deductible or coinsurance)
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Budget & Smart
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$1,000 Lifetime Maximum (subject to a maximum of 15 days, not subject to deductible or coinsurance)
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