Benefits | Coverage |
Emergency Medical Evacuation | $100,000 |
Return of Mortal Remains | $100,000 |
Pre-existing conditions | Covered after 6 months |
Coinsurance? | In Network: 80% of the preferred allowance Outside the Network: 60% of usual, reasonable and customary (URC) |
Hospital Room and Board Charges | $250 Inpatient or Outpatient Co-Pay |
Emergency Room | $250 co-pay per visit(waived if admitted) |
Prescription Drugs | Pay and Claim; Covered up to the Policy Maximum. |
Maternity | Not Available |
Emergency Reunion | $50 per day up to $10,000 Maximum |
Dental Treatment | $250 per tooth to a Maximum of $500 per Period of Insurance |
Mental or Nervous Disorders | Inpatient: up to a Max of 40 days Outpatient: up to a $500 Max per Period of Insurance |
Physiotherapy/Chiropractic Care | $500 Maximum per Period of Insurance |
Ambulance Benefit | $350 |
Primary Care Physician | $30 Co-Pay |
Consultation Fee | $50 Co-Pay |
Specialist Visits | $50 Co-Pay |
Student Health Center | $0 Co-Pay |
Home Country Coverage | Up to 30 days or $1,000 whichever comes first |