Global Care Plus Sports International Student Insurance

Global Care Plus Sports

PGH Global strives to offer plans that are comprehensive and meet a multitude of minimum requirements. However, requirements differ by institution.

Eligibility

All international students, scholars or other persons with a current passport who: 1) are engaged in educational activities; and 2) are temporarily located outside his/her home country as a non resident alien; and 3) have not obtained permanent residency status in the U.S. are eligible to enroll in this plan. Those enrolled in an English language or similar program or an Optional Practical Training Program or with an F or J visa are also eligible to enroll in this plan.

Students, with the exception of those with a J visa or those engaged in an Optional Practical Training Program, must actively attend classes for at least the first 31 days after the date for which coverage is purchased. Home study, correspondence and online courses do not fulfill the Eligibility requirements that the student actively attend classes. The Company maintains its right to investigate Eligibility or student status and attendance records to verify that the policy Eligibility requirements have been met.If the Company discovers the Eligibility requirements have not been met, its only obligation is to refund premium.

Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the student's legal spouse and dependent children under 26 years of age.

Dependent Eligibility expires concurrently with that of the Insured student.

US Citizens are not eligible for coverage as a student or a dependent.

Highlights of the Coverage and Services offered by Student Resources (SPC) Ltd.,a UnitedHealth Group Company
	Preferred Providers	Out-of-Network Providers
Overall Plan Maximum	There is no overall maximum dollar limit on the policy
Plan Deductible	$100 per Insured Person, per Policy Year	$300 per Insured Person, per Policy Year
Out-of-Pocket Maximum After the Out-of-Pocket Maximum has been satisfied, Covered Medical Expenses will be paid at 100% for the remainder of the Policy Year subject to any applicable benefit maximums. Refer to th e plan brochure for details about how the Out-of-Pocket Maximum applies.	$6,350 Per Insured Person, Per Policy Year $12,700 for all insured in a Family, per Policy Year	$8,000 Per Insured Person, Per Policy Year $16,000 for all insured in a Family, per Policy Year
Coinsurance All benefits are subject to satisfaction of the Deductible, specific benefit limitations, maximums and Copays as described in the plan brochure.	80% of Preferred Allowance for Covered Medical Expenses	70% of Usual and Customary Charges for Covered Medical Expenses
Prescription Drugs Prescriptions must be filled at a UHCP network pharmacy. Mail order through UHCP at 2.5 times the retail Copay up to a 90 day supply.	$15 Copay for Tier 1 20% Coinsurance for Tier 2 30% Coinsurance for Tier 3 Up to a 31-day supply per prescription filled at a UnitedHealthcare Pharmacy (UHCP	No Benefits
Preventive Care Services Including but not limited to: annual physicals, GYN exams, routine screenings and immunizations. No Copay or Deductible when the services are received from a Preferred Provider. Preventive care limits apply based on age and risk group factors.	100% of Preferred Allowance	No Benefits
The following services have per Service Copays/Deductibles This list is not all inclusive. Please read the plan brochure for complete listing of Copays/Deductibles.	Physician Visits: $25 Medical Emergency: $200	Medical Emergency: $200
Pediatric Dental and Vision Benefits	Refer to the plan brochure for details (age limits apply).
UnitedHealthcare Global: Global Emergency Services	International Students are covered worldwide except in their home country.
Intercollegiate Sports $10,000 maximum for each Injury)	80% of Preferred Allowance for Covered Medical Expenses	70% of Usual and Customary Charges for Covered Medical Expenses

How much does the plan cost?

Rates	30-Day Rates *
Student 24 & Under	$123.00
Student 25-30	$172.20
Student 31-40	$293.10
Student 41+	$627.60
Spouse	$536.40
Each Child	$350.70

$50 co-pay for visits to doctors offices.
Plan (A) has a PPO of 90% in the network.
Plan (B) has a PPO of 100% in the network.
ID cards available instantly if applying online.
100% coverage for treatment received outside US / Canada.
Coverage for Non-US Citizens traveling to USA / Worldwide.
There is no age limit, and no medical required.
Coverage is immediate after home country departure.
Coverage available for US Citizens traveling abroad.
Emergency evacuation & repatriation cover is included.

No benefits will be paid for:
a) loss or expense caused by, contributed to, or resulting from; or b) treatment, services or supplies for, at, or related to any of the following: Acne; Acupuncture; Addiction, such as: nicotine addiction, except as specifically provided in the policy; and caffeine addiction; non-chemical addiction, such as: gambling, sexual, spending, shopping, working and religious; codependency; Biofeedback; Injections; Cosmetic procedures, except cosmetic surgery required to correct an Injury for which benefits are otherwise payable under this policy or for newborn or adopted children; Custodial Care; care provided in: rest homes, health resorts, homes for the aged, halfway houses, college infirmaries or places mainly for domiciliary or Custodial Care; extended care in treatment or substance abuse facilities for domiciliary or Custodial Care; Dental treatment, except for accidental Injury to Sound, Natural Teeth; Elective Surgery or Elective Treatment; Eye examinations, eye refractions, eyeglasses, contact lenses, prescriptions or fitting of eyeglasses or contact lenses, vision correction surgery, or other treatment for visual defects and problems; except when due to a covered Injury or disease process; Routine foot care including the care, cutting and removal of corns, calluses, and bunions (except capsular or bone surgery); Health spa or similar facilities; strengthening programs; Immunizations, except as specifically provided in the policy; preventive medicines or vaccines, except where required for treatment of a covered Injury or as specifically provided in the policy; Injury or Sickness for which benefits are paid or payabletion or Occupational Disease Law or Act, or similar legislation; Injury or Sickness inside the Insured’s home country; < Injury or sickness outside the United States and its possessions, except when traveling for academic study abroad programs, business or pleasure, or to or from the Insured's home country; Injury or Sickness when claims payment and/or coverage is prohibited by applicable law; Injury sustained while (a) participating in any interscholastic, or professional sport, contest or competition; (b) traveling to or from such sport, contestor competition as a participant; or (c) while participating in any practice or conditioning program for such sport, contest or competition; Investigational services; Participation in a riot or civil disorder; commission of or attempt to commit a felony; Prescription Drugs, services or supplies as follows: Therapeutic devices or appliances, including: hypodermic needles, syringes, support garments and other non-medical substances, regardless of intended use, except as specifically provided in the policy; Immunization agents, except as specifically provided in the policy, biological sera, blood or blood products administered on an outpatient basis; Drugs labeled, “Caution - limited by federal law to investigational use” or experimental drugs; Products used for cosmetic purposes; Drugs used to treat or cure baldness; anabolic steroids used for body building; Anorectics - drugs used for the purpose of weight control; Fertility agents or sexual enhancement drugs, such as Parlodel, Pergonal, Clomid, Profasi, Metrodin, Serophene, or Viagra; Growth hormones; or Refills in excess of the number specified or dispensed after one (1) year of date of the prescription. Reproductive/Infertility services including but not limited to: family planning; fertility tests; infertility (male or female), including any services or supplies rendered for the purpose or with the intent of inducing conception; premarital examinations; impotence, organic or otherwise; female sterilization procedures, except as specifically provided in the policy; vasectomy; sexual reassignment surgery; reversal of sterilization procedures; Research or examinations relating to research studies, or any treatment for which the patient or the patient’s representative must sign an informed consent document identifying the treatment in which the patient is to participate as a research study or clinical research study; Routine Newborn Infant Care, well-baby nursery and related Physician charges; in excess of 48 hours for vaginal delivery or 96 hours for cesarean delivery; Preventive care services; routine physical examinations and routine testing; preventive testing or treatment; screening exams or testing in the absence of Injury or Sickness; except as specifically provided in the policy; Services provided normally without charge by the Health Service of the institution attended by the Insured; or services covered or provided by a student health fee; Deviated nasal septum, including submucous resection and/or other surgical correction thereof; nasal and sinus surgery, except for treatment of a covered Injury or treatment of chronic purulent sinusitis; except as specifically provided in the policy; Skydiving, parachuting, hang gliding, glider flying, parasailing, sail planing, bungee jumping, or flight in any kind of aircraft, except while riding as a passenger on a regularly scheduled flight of a commercial airline; Supplies, except as specifically provided in the policy; Surgical breast reduction, breast augmentation, breast implants or breast prosthetic devices, or gynecomastia; except as specifically provided in the policy; Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such treatment; War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will be refunded upon request for such period not covered); and Weight management, weight reduction, nutrition programs, treatment for obesity, surgery for removal of excess skin or fat.

No benefits will be paid for:

a) loss or expense caused by, contributed to, or resulting from; or
b) treatment, services or supplies for, at, or related to any of the following:

Acne;
Acupuncture;
Addiction, such as: nicotine addiction, except as specifically provided in the policy; and caffeine addiction; non-chemical addiction, such as: gambling, sexual, spending, shopping, working and religious; codependency;
Biofeedback;
Injections;
Cosmetic procedures, except cosmetic surgery required to correct an Injury for which benefits are otherwise payable under this policy or for newborn or adopted children;
Custodial Care; care provided in: rest homes, health resorts, homes for the aged, halfway houses, college infirmaries or places mainly for domiciliary or Custodial Care; extended care in treatment or substance abuse facilities for domiciliary or Custodial Care;
Dental treatment, except for accidental Injury to Sound, Natural Teeth;
Elective Surgery or Elective Treatment;
Eye examinations, eye refractions, eyeglasses, contact lenses, prescriptions or fitting of eyeglasses or contact lenses, vision correction surgery, or other treatment for visual defects and problems; except when due to a covered Injury or disease process;
Routine foot care including the care, cutting and removal of corns, calluses, and bunions (except capsular or bone surgery);
Health spa or similar facilities; strengthening programs;
Immunizations, except as specifically provided in the policy; preventive medicines or vaccines, except where required for treatment of a covered Injury or as specifically provided in the policy;
Injury or Sickness for which benefits are paid or payabletion or Occupational Disease Law or Act, or similar legislation;
Injury or Sickness inside the Insured’s home country;
Injury or sickness outside the United States and its possessions, except when traveling for academic study abroad programs, business or pleasure, or to or from the Insured's home country;
Injury or Sickness when claims payment and/or coverage is prohibited by applicable law;
Injury sustained while (a) participating in any interscholastic, or professional sport, contest or competition; (b) traveling to or from such sport, contestor competition as a participant; or (c) while participating in any practice or conditioning program for such sport, contest or competition;
Investigational services;
Participation in a riot or civil disorder; commission of or attempt to commit a felony;
Prescription Drugs, services or supplies as follows:
- Therapeutic devices or appliances, including: hypodermic needles, syringes, support garments and other non-medical substances, regardless of intended use, except as specifically provided in the policy;
- Immunization agents, except as specifically provided in the policy, biological sera, blood or blood products administered on an outpatient basis;
- Drugs labeled, “Caution - limited by federal law to investigational use” or experimental drugs;
- Products used for cosmetic purposes;
- Drugs used to treat or cure baldness; anabolic steroids used for body building;
- Anorectics - drugs used for the purpose of weight control;
- Fertility agents or sexual enhancement drugs, such as Parlodel, Pergonal, Clomid, Profasi, Metrodin, Serophene, or Viagra;
- Growth hormones; or
- Refills in excess of the number specified or dispensed after one (1) year of date of the prescription.
Reproductive/Infertility services including but not limited to: family planning; fertility tests; infertility (male or female), including any services or supplies rendered for the purpose or with the intent of inducing conception; premarital examinations; impotence, organic or otherwise; female sterilization procedures, except as specifically provided in the policy; vasectomy; sexual reassignment surgery; reversal of sterilization procedures;
Research or examinations relating to research studies, or any treatment for which the patient or the patient’s representative must sign an informed consent document identifying the treatment in which the patient is to participate as a research study or clinical research study;
Routine Newborn Infant Care, well-baby nursery and related Physician charges; in excess of 48 hours for vaginal delivery or 96 hours for cesarean delivery;
Preventive care services; routine physical examinations and routine testing; preventive testing or treatment; screening exams or testing in the absence of Injury or Sickness; except as specifically provided in the policy;
Services provided normally without charge by the Health Service of the institution attended by the Insured; or services covered or provided by a student health fee;
Deviated nasal septum, including submucous resection and/or other surgical correction thereof; nasal and sinus surgery, except for treatment of a covered Injury or treatment of chronic purulent sinusitis; except as specifically provided in the policy;
Skydiving, parachuting, hang gliding, glider flying, parasailing, sail planing, bungee jumping, or flight in any kind of aircraft, except while riding as a passenger on a regularly scheduled flight of a commercial airline;
Supplies, except as specifically provided in the policy;
Surgical breast reduction, breast augmentation, breast implants or breast prosthetic devices, or gynecomastia; except as specifically provided in the policy;
Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such treatment;
War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will be refunded upon request for such period not covered); and
Weight management, weight reduction, nutrition programs, treatment for obesity, surgery for removal of excess skin or fat.

Global Care Plus Sports No Overall Maximum Dollar Limit with 80% IN PPO Coverage

Global Care Plus Sports