Student Health Advantage Benefits

Maximum Limits

Student: $500,000 Dependent: $100,000

Deductibles

$250 per injury or illness. Student Health Center: $5

Coinsurance Outside the U.S. and Canada

 No coinsurance

In U.S. and Canada

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.) 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 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.  $10,000 maximum limit

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 $350 per illness resulting in an inpatient hospitalization or injury.

Dental

Injury due to covered Accident: $500

 

Sudden & Unexpected Pain to natural teeth: $350

Eligible Medical Expenses

URC 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 12 months of continuous coverage

 

 

 

 

*Terms and Conditions of the contract do apply