Student Health Advantage Benefits

Maximum Limits

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

Deductibles

$100 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

URC

Maternity- Outside U.S. & Canada

100% eligible medical expenses to maximum limit

In U.S. and Canada

PPO Provider: 80% eligible medical expenses to maximum limit

NON PPO Provider: 60% eligible medical expenses to maximum limit

Routine Newborn Care

$750 maximum per period of coverage

Emergency Room Injury

URC

Emergency Room Illness with In-patient admission

Up to Maximum Limit

Emergency Room without In-patient admission

URC Subject to additional $250 Deductible

Mental & Nervous Disorders

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

In-Patient: URC to $10,000 lifetime maximum

Prescription Drugs

In-Patient: URC Out-Patient: 50% of actual charges

Physical Therapy

URC- limit once per day

Local Ambulance

Up to $350

Dental

Injury due to covered Accident: $500

Sudden & Unexpected Pain to natural teeth: $350

Eligible Medical Expenses

URC

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