Student Insurance for Sports Coverage Benefit

• Non US citizens and Non-US residents while visiting the United States
• Coverage is NOT available for Australian Citizens.
• This plan does not offer coverage for any travel outside the United States.

• The plan pays 80% up to $5,000 of eligible costs, then 100% to the medical maximum. Additional $250 deductible for each emergency room visit as a result of an Illness is available. The emergency room deductible will be waived if hospital admittance is within 12 hours of the incident

• "The plan is not renewable”, if additional coverage time is needed, a new application must be completed.

The Traveler can purchase an optional rider at the time of application. The optional riders provide additional coverage for a minimal charge.

• Enhanced Political and Natural Disaster Evacuation Rider
  × Enhanced Political and Natural Disaster Evacuation Rider

  • Coverage provided by this rider is up to $50,000

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• Athletic and Hazardous Activity Rider
  × Athletic and Hazardous Activity Rider

  • The medical maximum provided is reduced to $20,000 for any illness or injury incurred from any athletic sport & hazardous activity not expressly covered here under is excluded from this policy unless the activity is non-contact and engaged in by you solely for leisure, recreation, entertainment, or fitness purposes only.
  • For the below listed activities apply the 1.25 factor to the base premium: Bobsledding; Bungee Jumping; Canopying; Hang Gliding; HeliJskiing; Horseback Riding; Jet, Snow, and Water Skiing; Kayaking; Martial Arts; Motorcycling & Motor Scooter; Mountain Biking; Mountain Climbing (under 14,000 feet); Paragliding; Parasailing; Piloting any NonJcommercial Aircraft; Safari; Scuba Diving, Skydiving; Snowboarding; Snowmobiling; Spelunking; Surfing; Trekking; Whitewater Rafting (up to and including Class V Rapid only); Wind Surfing; Zip Lining.
  • For the below listed activities apply the 1.25 factor to the base premium plus the monthly flat rate listed:
    • Low-Option additional $25.00 flat monthly rate: Arial Photograph (Use of proper restraints required); BMX (Racing or Competitive); Flying in any Chartered or Leased Aircraft or Helicopter.
    • High-Option additional $50.00 flat monthly rate: Diving with Sharks; Mountain Climbing (if over 14 thousand feet, guide required); Running with Bulls; Safari & Big Game Hunting (use of firearms); Security Detail (use of firearms).
  • For the below listed Intercollegiate, Interscholastic Athletics, Club Sports, and Organized Amateur Sports, apply the 1.25 factor to the base premium plus the monthly flat rate listed:
    • Low-Option additional $12.00 flat monthly rate: Baseball; Cheerleading; Cross Country; Diving; Equestrian; Fencing; Field Hockey; Golf; Polo Horse; Polo Water; Softball; Swimming; Tennis; Track and Field; Volleyball.
    • Middle-Option additional $26.00 flat monthly rate: Basketball; Competitive Cycling (Road, Track, CX); Ice Hockey; Lacrosse; Martial Arts; Skiing (Slalom, Giant Slalom, Downhill); Wrestling.
    • High-Option additional $80.00 flat monthly rate: Football (no Division One); Gymnastics; Rugby; Soccer.

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• Non US Residents while visiting the US.
• Individuals travelling outside their home country.

• For treatment received outside the U.S : No coinsurance.
• For treatment received within the U.S :
• Inside of the United States: The plan pays 80% up to $5,000 of eligible costs, then 100% to the medical maximum. Additional $250 deductible for each emergency room visit as a result of an Illness is available. The emergency room deductible will be waived if hospital admittance is within 12 hours of the incident.
• Outside of the United States: The plan pays 100% to the medical maximum outside USA and Canada.

• "The plan is not renewable”, if additional coverage time is needed, a new application must be completed.

The Traveler can purchase an optional rider at the time of application. The optional riders provide additional coverage for a minimal charge.

• Home Country Coverage Rider
  × Home Country Coverage Rider

  • Offers limited coverage while in the home country.The plans pays 80% up to $50,000 of the covered expenses, then 100% to a maximum of $50,000 for incidental trips to home country or $10,000 for extension of benefits.

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• Enhanced Political and Natural Disaster Evacuation Rider
  × Enhanced Political and Natural Disaster Evacuation Rider

  • Coverage provided by this rider is up to $50,000

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• Athletic and Hazardous Activity Rider
  × Athletic and Hazardous Activity Rider

  • The medical maximum provided is reduced to $20,000 for any illness or injury incurred from any athletic sport & hazardous activity not expressly covered here under is excluded from this policy unless the activity is non-contact and engaged in by you solely for leisure, recreation, entertainment, or fitness purposes only.
  • For the below listed activities apply the 1.25 factor to the base premium: Bobsledding; Bungee Jumping; Canopying; Hang Gliding; HeliJskiing; Horseback Riding; Jet, Snow, and Water Skiing; Kayaking; Martial Arts; Motorcycling & Motor Scooter; Mountain Biking; Mountain Climbing (under 14,000 feet); Paragliding; Parasailing; Piloting any NonJcommercial Aircraft; Safari; Scuba Diving, Skydiving; Snowboarding; Snowmobiling; Spelunking; Surfing; Trekking; Whitewater Rafting (up to and including Class V Rapid only); Wind Surfing; Zip Lining.
  • For the below listed activities apply the 1.25 factor to the base premium plus the monthly flat rate listed:
    • Low-Option additional $25.00 flat monthly rate: Arial Photograph (Use of proper restraints required); BMX (Racing or Competitive); Flying in any Chartered or Leased Aircraft or Helicopter.
    • High-Option additional $50.00 flat monthly rate: Diving with Sharks; Mountain Climbing (if over 14 thousand feet, guide required); Running with Bulls; Safari & Big Game Hunting (use of firearms); Security Detail (use of firearms).
  • For the below listed Intercollegiate, Interscholastic Athletics, Club Sports, and Organized Amateur Sports, apply the 1.25 factor to the base premium plus the monthly flat rate listed:
    • Low-Option additional $12.00 flat monthly rate: Baseball; Cheerleading; Cross Country; Diving; Equestrian; Fencing; Field Hockey; Golf; Polo Horse; Polo Water; Softball; Swimming; Tennis; Track and Field; Volleyball.
    • Middle-Option additional $26.00 flat monthly rate: Basketball; Competitive Cycling (Road, Track, CX); Ice Hockey; Lacrosse; Martial Arts; Skiing (Slalom, Giant Slalom, Downhill); Wrestling.
    • High-Option additional $80.00 flat monthly rate: Football (no Division One); Gymnastics; Rugby; Soccer.

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