Plan Features |
International Student Insurance Care - Basic |
International Student Insurance Care - Gold |
International Student Insurance Care - Silver |
International Student Insurance Care - Sports Care Plus |
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 For J visa are also eligible to enroll in the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes tor at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program. |
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 the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes for at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program. |
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 the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes for at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program. |
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 the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes for at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program. |
Maximum Benefit |
$500,000 (For each Injury or Sickness) |
No Overall Maximum Dollar Limit |
No Overall Maximum Dollar Limit |
No Overall Maximum Dollar Limit |
Network |
Preferred Provider |
Out of Network |
Preferred Provider |
Out-of-Network |
Preferred Provider |
Out-of-Network |
Preferred Provider |
Out-of-Network |
Deductible |
$100 (Waived at Student Health Center) |
$500 |
$50 Per Insured Person, Per Policy Year (Waived at Student Health Center) |
$300 |
$100 Per Insured Person, Per Policy Year (Waived at Student Health Center) |
$300 |
$100 Per Insured Person, Per Policy Year (Waived at Student Health Center) |
$300 |
Co-insurance |
80% except as noted |
70% except as noted |
90% except as noted |
70% except as noted |
80% except as noted |
70% except as noted |
80% except as noted |
70% except as noted |
Out of Pocket Maximum |
$10,000 (Per Insured Person, Per Policy Year) |
N/A |
$5,000 (Per Insured Person, Per Policy Year). $10,000 (For all Insureds in a Family, Per Policy Year). |
$7,000 (Per Insured Person, Per Policy Year). $14,000 (For all Insureds in a Family, Per Policy Year). |
$6,350 (Per Insured Person, Per Policy Year). $12,700 (For all Insureds in a Family, Per Policy Year). |
$8,000 (Per Insured Person, Per Policy Year). $16,000 (For all Insureds in a Family, Per Policy Year). |
$6,350 (Per Insured Person, Per Policy Year). $12,700 (For all Insureds in a Family, Per Policy Year). |
$8,000 (Per Insured Person, Per Policy Year). $16,000 (For all Insureds in a Family, Per Policy Year). |
Pre-existing Waiting Period |
6 months |
None |
None |
None |
INPATIENT |
INPATIENT |
INPATIENT |
INPATIENT |
INPATIENT |
Room & Board/Hosp Misc: |
80% Preferred Allowance/$100 Copay per Hospital Confinement |
70% Usual and Customary Charges/$100 Deductible per Hospital Confinement |
90% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
Routine Newborn Care (Max 4 Days): |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
Surgery: |
80% Preferred Allowance |
70% Usual and Customary Charges |
90% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
Physician's Visits: |
80% Preferred Allowance |
70% Usual and Customary Charges |
90% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
Psychotherapy: |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
OUTPATIENT |
OUTPATIENT |
OUTPATIENT |
OUTPATIENT |
OUTPATIENT |
Surgery: |
80% Preferred Allowance |
70% Usual and Customary Charges |
90% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
Physician's Visits: |
80% Preferred Allowance /$30 Copay per visit |
70% Usual and Customary Charges |
90% Preferred Allowance/$20 Copay per visit |
70% Usual and Customary Charges |
80% Preferred Allowance/$25 Copay per visit |
70% Usual and Customary Charges |
80% Preferred Allowance/$25 Copay per visit |
70% Usual and Customary Charges |
Medical Emergency: |
80% Preferred Allowance /$100 Copay per visit |
70% Usual and Customary Charges /$100 Deductible per visit |
90% Preferred Allowance/$150 Copay per visit |
70% Usual and Customary Charges/$150 Deductible per visit |
80% Preferred Allowance/$200 Copay per visit |
70% Usual and Customary Charges/$200 deductible per visit |
80% Preferred Allowance/$200 Copay per visit |
70% Usual and Customary Charges/$200 deductible per visit |
X-Rays & Laboratory |
80% Preferred Allowance |
70% Usual and Customary Charges |
90% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
Prescription Drugs: |
UnitedHealthcare Pharmacy (UHCP) $20 Copay per prescription for Tier 1. 30% Coinsurance per prescription for Tier 2. 40% Coinsurance per prescription for Tier 3. Up to a 31-day supply per prescription ($2,500 maximum). |
UnitedHealthcare Pharmacy (UHCP) $15 Copay per prescription for Tier 1. $30 Copay per prescription for Tier 2. $50 Copay per prescription for Tier 3. Up to a 31 day supply per prescription. |
UnitedHealthcare Pharmacy (UHCP) $15 Copay per prescription for Tier 1. 20% Coinsurance per prescription for Tier 2. 30% Coinsurance per prescription for Tier 3. Up to a 31 day supply per prescription. |
UnitedHealthcare Pharmacy (UHCP) $15 Copay per prescription for Tier 1. 20% Coinsurance per prescription for Tier 2. 30% Coinsurance per prescription for Tier 3. Up to a 31 day supply per prescription. |
Psychotherapy |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
CAT/MRI |
80% Preferred Allowance /$200 Copay per visit |
70% Usual and Customary Charges /$200 Deductible per visit |
90% Preferred Allowance/$100 Copay per visit |
70% Usual and Customary Charges/$100 Deductible per visit |
80% Preferred Allowance/$150 Copay per visit |
70% Usual and Customary Charges/$150 deductible per visit |
80% Preferred Allowance/$150 Copay per visit |
70% Usual and Customary Charges/$150 deductible per visit |
Urgent Care |
80% Preferred Allowance /$50 Copay per visit |
70% Usual and Customary Charges /$50 Deductible per visit |
90% Preferred Allowance/$50 Copay per visit |
70% Usual and Customary Charges/$50 Deductible per visit |
80% Preferred Allowance/$50 Copay per visit |
70% Usual and Customary Charges/$50 deductible per visit |
80% Preferred Allowance/$50 Copay per visit |
70% Usual and Customary Charges/$50 deductible per visit |
Preventive Care Services (Per PPACA) |
100% of Preferred Allowance / $1,000 Maximum Per Policy Year |
No Benefits |
100% of Preferred Allowance |
No Benefits |
100% of Preferred Allowance |
No Benefits |
100% of Preferred Allowance |
No Benefits |
OTHER |
OTHER |
OTHER |
OTHER |
OTHER |
Ambulance: |
80% Preferred Allowance |
70% Usual and Customary Charges |
90% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
80% Preferred Allowance |
70% Usual and Customary Charges |
Alcoholism/Drug Abuse: |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
Maternity & Complications of Pregnancy |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
Paid as any other Sickness |
Repatriation |
Benefits provided by UnitedHealthcare Global |
Benefits provided by UnitedHealthcare Global |
Benefits provided by UnitedHealthcare Global |
Benefits provided by UnitedHealthcare Global |
Medical Evacuation |
Benefits provided by UnitedHealthcare Global |
Benefits provided by UnitedHealthcare Global |
Benefits provided by UnitedHealthcare Global |
Benefits provided by UnitedHealthcare Global |
Intercollegiate Sports |
No Benefits |
No Benefits |
No Benefits |
No Benefits |
No Benefits |
No Benefits |
80% Preferred Allowance/$10,000 Maximum for Each Injury |
70% Usual and Customary Charges/$10,000 Maximum for Each Injury |