Collegiate Care Premier

Plan Detail

Plan Administrator: Trawick International | AM Best Rating: A "Excellent" | Underwriter: United States Fire Insurance Company

Benefits


 

Benefits Limit
Maximum for all Medical Expense: $500,000 ($250,000 at Age 51)
Deductible: per Injury or Sickness $0 if first treated by the Student Health Center
$100 if not first treated by the Student Health Center
Co-insurance Rate: 80% of the first $10,000, then 100% to Plan Maximum
Maximum Benefit Period: 1 year from the date of the Covered Accident or Sickness
Maternity: Same as any other Sickness
Mental or Nervous Disorders: Inpatient: Up to a maximum of 40 days
Outpatient: Up to a $500 Maximum
Alcohol and Drug Abuse: 50% up to $1,000
Motor Vehicle Accident Maximum: $10,000
Physiotherapy Physical Medicine/Chiropractic Care: $500 maximum
Room and Board Charges: Semi Private Room Rate
ICU Room and Board Charges: Covered
Inpatient/Outpatient Surgery: Covered
Sports Related Injury: $10,000
Dental Treatment (Injury and emergency
alleviation of pain):
$250 per tooth to a maximum of $500
Pap Smear: One per Policy Year
Ambulance Benefit: $350
Emergency Evacuation: $50,000

We will pay up to $50,000 of Covered Expenses if you are traveling outside of your Home Country and suffer an Injury or Sickness during the course of the Trip which requires Emergency Medical Evacuation from the place where you suffer an Injury or Sickness to the nearest Hospital or other medical facility where appropriate medical treatment can be obtained; or transportation to your Home Country to obtain further medical treatment in a Hospital or other medical facility or to recover after suffering an Injury or Sickness. An Emergency Medical Evacuation includes Medically Necessary medical treatment, medical services and medical supplies necessarily received in connection with such transportation.
Repatriation: $25,000

We will pay 100% of Covered Expenses up to $25,000 for preparation and return of your body to your Home Country if you die due to an Injury or Sickness. Benefits will not be payable unless We authorize in writing or by an authorized electronic or telephonic means all expenses in advance. Covered expenses include: 1. expenses for embalming or cremation; 2. the least costly coffin or receptacle adequate for transporting the remains; 3. transporting the remains by the most direct and least costly conveyance and route possible.
Emergency Reunion: $10,000

Up to $10,000 maximum for the cost of one economy airfare ticket and other local travel related expenses; or the reasonable expenses incurred for lodging and meals of your Immediate Family Member for a period of up to 10 days to accompany you to your Home Country or Hospital where you are confined if: 1. the Emergency Medical Evacuation Benefit is payable under the Policy; and 2. you are alone outside of your Home Country; and 3. the place of confinement is more than 100 miles from your Home Country; and 4. expenses were authorized in advance by the Company.
Trip Cancellation / Interruption / Delay $10,000
Lost / Stolen Baggage $3,500
Accidental Death & Dismemberment Benefit Principal Sum Insured $10,000
If Injury results, within 365 days from date of Accident in any one of the losses shown below, We will pay the Benefit Amount shown below for that loss. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Accident.

Covered Loss                                                                                                                   Benefit Amount
Life or Quadriplegia or Two or more Members                                                     100% of the Principal Sum
Hemiplegia or Paraplegia                                                                                          75% of the Principal Sum
One Member                                                                                                                  50% of the Principal Sum
Uniplegia or Thumb and Index Finger of the Same Hand                                    25% of the Principal Sum

Exposure and Disappearance Benefit - 100% of the Principal Sum if you are exposed to the elements after the forced landing, stranding, sinking, or wrecking of a vehicle in which you were traveling. You are presumed dead if you are in a vehicle that disappears, sinks or is stranded or wrecked and your body is not found within six months of the Covered Accident.

Hijacking and Air or Water Piracy Benefit - Covers Injury during the:
1. hijacking of an Aircraft;
2. air or water piracy; or
3. unlawful seizure or attempted seizure of an aircraft or watercraft.
Coma Benefit We will pay this benefit in a lump sum of $10,000 if you become Comatose within 31 days of a Covered Accident or Sickness and remain in a Coma for at least 31 days.
Seatbelt and Airbag Benefit 10% of the Principal Sum up to a maximum benefit of $1,000 If you die or are dismembered directly and independently from Injuries sustained while wearing a seatbelt and operating or riding as a passenger in an Automobile.
Felonious Assault and Violent Crime Benefit 100% of the Principal Sum applicable to the Covered Loss to a maximum of $10,000.
Adaptive Home and Vehicle Benefit Equal to the least of either the actual cost of the alterations or $5,000 for the one-time cost of alterations to your principal residence; and/or private Automobile.
Home Country Coverage Up to $1,000 for Covered Expenses incurred within 30 days of your return to your Home Country relating to an Injury or Sickness which occurred, was diagnosed and treated outside your Home Country during your period of coverage. Or during the period of coverage, for incidental visits of up to 30 days. If during an incidental trip home you suffer an Injury or Sickness, this Plan shall pay for that Injury or Sickness. Treatment for this Injury or Sickness must occur within the Insured’s Home Country while on the incidental visit.

Primary Benefits

We will pay Accident and Sickness Medical Expenses up to the Maximum Benefit as outlined in the Schedule of Benefits and after each Insured satisfies any Deductible, without regard to any other Health Care Plan benefits payable for the Insured. We will pay these benefits without regard to any Coordination of Benefits provision in any other Health Care Plan.

Covered Medical Expenses Benefit

If a covered Injury or Sickness occurs during the period of coverage and you require medical or surgical treatment; this plan will pay, subject to the selected deductible, applicable co-insurance and benefit maximums, the following Covered Expenses, up to the selected policy maximum. The first charges must be incurred within 90 days after the date of the Covered Accident or Sickness. No benefits will be paid for any expenses incurred which are in excess of Usual and Customary Charges.

  • Hospital Room and Board Expenses: the average daily rate for a semi private room when a Covered Person is Hospital Confined and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge.
  • Ancillary Hospital Expenses: services and supplies including operating room, laboratory tests, anesthesia and medicines when Hospital Confined. This does not include personal services of a non-medical nature.
  • Daily Intensive Care Unit Expenses: three times the average semi private room rate when a Covered Person is Hospital Confined in a bed in the Intensive Care Unit and nursing services other than private duty nursing services.
  • Medical Emergency Care (room and supplies) Expenses: incurred within 72 hours of an Accident or Sickness and including the attending Doctor’s charges, X-rays, laboratory procedures, use of the emergency room and supplies.
  • Doctor Non-Surgical Treatment and Examination Expenses including the Doctor’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Doctor. 6. Doctor’s Surgical Expenses.
  • Assistant Surgeon Expenses when Medically Necessary.
  • Anesthesiologist Expenses for pre-operative screening and administration of anesthesia during a surgical procedure whether on an inpatient or outpatient basis.
  • Physiotherapy Physical Medicine/Chiropractic Expenses on an inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Doctor, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy and limited to $500 per policy period.
  • X-ray Expenses (including reading charges).
  • Dental Expenses up to $ 250 due to Accidents or emergency alleviation of pain including dental x-rays for the repair or treatment of each tooth that is whole, sound and a natural tooth at the time of the Accident or emergency alleviation of dental pain.
  • Ambulance Expenses for transportation from the emergency site to the Hospital by licensed ground ambulance only, to a limit of $350.
  • Prescription Drug Expenses including dressings, drugs and medicines prescribed by a Doctor.
  • Medical Services and Supplies: expenses for blood and blood transfusions; oxygen and its administration.
  • Mental or nervous disorders or rest cures up the maximum stated per policy period. 16. One annual Pap Smear.

Extension of Benefits

Your coverage will be extended if you are Hospital confined for a Covered Injury or Sickness and under the care of a Physician on the termination date of your Period of Coverage. Coverage will terminate on the earlier of the following:
  • Thirty (30) days from the end of your Period of Coverage;
  • The maximum benefit has been paid; or
  • Your release from the hospital or Physician care.

DEFINITIONS

Please note, certain words used in this document have specific meanings. These terms will be capitalized throughout the document.

“Accident” means a sudden, unexpected and unintended event. “Covered Accident” means an Accident that occurs while coverage is in force for a Covered Person and results in a loss or Injury covered by the Policy for which benefits are payable. “Covered Expenses” means expenses actually incurred by or on behalf of a Covered Person for treatment, services and supplies covered by the Policy. Coverage under the Policy must remain continuously in force from the date of the Accident or Sickness until the date treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date such treatment, service or supply, that gave rise to the expense or the charge, was rendered or obtained. “Covered Loss” or “Covered Losses” means an accidental death, dismemberment or other Injury covered under the Policy. “Deductible” means the dollar amount of Covered Expenses that must be incurred as an out of-pocket expense by each Covered Person on a per Policy Term basis before Medical Expense Benefits and/or other Additional Benefits paid on an expense incurred basis are payable under the Policy. “Dependent” means an Insured’s unmarried child, from the moment of birth to age 18, who is chiefly dependent on the Insured for support. “Doctor” means a licensed health care provider acting within the scope of his or her license and rendering care or treatment to a Covered Person that is appropriate for the conditions and locality. It will not include a Covered Person or a member of the Covered Person’s Immediate Family Member or household. “Domestic Partner” means a person of the same or opposite sex of the Insured who:
  • shares the Insured’s primary residence;
  • has resided with the Insured for at least 6 months prior to the date of enrollment and is expected to reside with the Insured indefinitely;
  • is financially interdependent with the Insured
  • has signed a Domestic Partner declaration with the Insured, if recognized by the laws of the state in which he or she resides with the Insured;
  • does not have current Domestic Partner declaration with any other person;
  • is older than 18 years of age;
  • is not currently married to another person; and
  • is not in a position as a blood relative that would prohibit marriage.

“Home Country” means a country from which the Covered Person holds a passport. If the Covered Person holds passports from more than one country, his or her Home Country will be that country which the Covered Person has declared to Us in writing as his or her Home Country. “Hospital” means an institution that:

  • operates as a Hospital pursuant to law for the care, treatment, and providing of in-patient services for sick or injured persons;
  • provides 24-hour nursing service by Registered Nurses on duty or call;
  • has a staff of one or more licensed Doctors available at all times;
  • provides organized facilities for diagnosis, treatment and surgery, either: (i) on its premises; or (ii) in facilities available to it, on a pre-arranged basis;
  • is not primarily a nursing care facility, rest home, convalescent home, or similar establishment, or any separate ward, wing or section of a Hospital used as such; and
  • is not a place solely for drug addicts, alcoholics, or the aged or any separate ward of the Hospital.

“Immediate Family Member” means a person who is related to the Covered Person in any of following ways: spouse; parent (includes stepparent); child (includes legally adopted and step child); brother or sister (includes stepbrother or stepsister); parent-in-law; son or daughter–in–law; and brother- or sister-in-law. “Injury” means accidental bodily harm sustained by a Covered Person that results directly and independently from all other causes from a Covered Accident. All injuries sustained by one person in any one Accident, including all related conditions and recurrent symptoms of these injuries, are considered a single Injury. “Pre-existing Condition shall mean any condition for which a licensed Physician was consulted, or for which Treatment or Medication was prescribed, or for which manifestations or symptoms would have caused a person to seek medical advice 12 months prior to the Effective Date of coverage under the Policy, except if the individual is covered under the Policy for 6 consecutive months, then the Pre-existing Condition exclusion will no longer apply and any eligible expenses incurred thereafter will be considered for reimbursement. “Sickness” means an illness, disease or condition of the Covered Person that causes a loss for which a Covered Person incurs medical expenses while covered under the Policy. All related conditions and recurrent symptoms of the same or similar condition will be considered one Sickness. “Usual and Customary Charge” means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided. “We”, “Our”, “Us” means Starr Indemnity & Liability Company or its authorized agent.