Assist international students locate lower premium with maximum benefits. Premium may lower than school offers.
| # | Essential Plan | Plus Plan | Elite Plan |
|---|---|---|---|
| Maximum Benefit | $100,000 (For Each Injury or Sickness) | No Overall Maximum Dollar Limit | No Overall Maximum Dollar Limit |
| Deductible | $150/$500 | $100/$500 | $100/$500 |
| Individual Out-of-Pocket Maximum | None | $6,850 | $5,000 |
| Physician's Visits | $35 Copay per visit | $30 Copay per visit | $25 Copay per visit |
| Medical Emergency | $250 Copay per visit and 20% | $250 Copay per visit and 20% | $200 Copay per visit and 10% |
|---|---|---|---|
| Ambulance | 20% after deductible | 20% after deductible | 10% after deductible |
| Room and Board | $100 Copay per visit and 20% | 20% after deductible | 10% after deductible |
| Outpatient Surgery | $100 Copay per visit and 20% | 20% after deductible | 10% after deductible |
| X-rays & Lab | $25 Copay per visit and 20% | 20% | 10% |
| Prescription Drugs | None |
$15 Copay per prescription Tier 1 30% Coinsurance per prescription Tier 2 45% Coinsurance per prescription Tier 3 |
$15 Copay per prescription Tier 1 30% Coinsurance per prescription Tier 2 45% Coinsurance per prescription Tier 3 |
| Preventive Care | None | Free | Free |
| Plan detail information |
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If you were previously covered by a U.S. health plan that issues you a Certificate of Creditable Coverage, will credit you for this prior coverage. The number of months of coverage shown on the Certificate will reduce or eliminate the 6 month pre-existing condition waiting period. If you have six or more months of creditable coverage, your waiting period will be eliminated. If you have less than six months creditable coverage, your waiting period will be reduced by the number of months you had creditable coverage. For example, if you have two months of creditable coverage, your waiting period will be reduced from six months to four months.
