Global Student USA

Plan Detail

Plan Administrator: HTH Worldwide | AM Best Rating: A "Excellent" | Underwriter: Unicare

Benefits


 

Coverages Limit
Medical Benefits
Lifetime Maximum $1,000,000
Policy Year Maximum $250,000
Maximum Benefit per Injury or Sickness  $250,000
Deductible per Injury or Sickness $100 reduced to $50 if treatment is initiated at a Recognized Student Health Center 
Physician Office Visits, Hospital Inpatient - Per Injury or Illness

First $10,000 Maximum: 80% of Reasonable Expenses after Deductible
 

Next $240,000: 100% of Reasonable Expenses

Inpatient Hospital services and Hospital and Physician Outpatient services consist of the following: Hospital room and board, including general nursing services, medical and surgical treatment, medical services and supplies, Outpatient nursing services provided by an RN, LPN or LVN, local, professional ground ambulance services to and from a local Hospital for Emergency Hospitalization and Emergency Medical Care, x rays, laboratory tests, prescription medicines, artificial limbs or
prosthetic appliances, including those which are functionally necessary, the rental or purchase, at the Insurer's option, of durable medical equipment for therapeutic use, including repairs and necessary maintenance of purchased equipment not provided for under a manufacturer's warranty or purchase agreement. The Insurer will not pay for Hospital room and board charges in excess of the prevailing semi-private room rate unless the requirements of Medically Necessary treatment dictate accommodations other than a semi-private room.

Medical Benefit Limitations
Maternity Care for a Covered Pregnancy Reasonable Expenses

The Insurer will pay the actual expenses incurred as a result of pregnancy, childbirth, miscarriage, or any Complications resulting from any of these, except to the extent shown in the Schedule of Benefits. Conception must have occurred while the Covered Person was insured under the Policy.
Inpatient treatment of mental and nervous disorders including drug or alcohol abuse Reasonable Expenses up to $5,000 Maximum lifetime 
Outpatient treatment of mental and nervous disorders including drug or alcohol abuse Reasonable Expenses up to $500 Maximum lifetime
Treatment of Specified therapies including acupuncture and physiotherapy Reasonable Expenses for up $10,000 maximum per Injury or Sickness on an Inpatient basis
Therapeutic termination of pregnancy Expenses up to $500 per Policy Year
Medical treatment arising from participation in intercollegiate, interscholastic, intramural or club sports Reasonable Expenses up to $5,000 Maximum per Policy Year
Medical treatment of Injuries sustained as a result of a covered motor vehicle accident Reasonable Expenses up to $10,000 Maximum per Policy Year
Repairs to sound, natural teeth required due to an Injury 100% of Reasonable Expenses up to $250 per tooth
Professional ground or air ambulance service to nearest hospital Reasonable Expenses up to $350 per Injury or Sickness
Outpatient prescription drugs 50% of actual charge
Home Country Coverage (While Insured) 100% of Reasonable Expenses up to $5,000 lifetime maximum

Home Country Coverage (While Insured): Expenses incurred within the Covered Person's Home Country while insured under the Policy will be considered as Covered Medical Expenses up to the limits stated in the Schedule of Benefits, if not covered by other plan.
Other Coverages
Accidental Death & Dismemberment N/A
Repatriation of Remains Maximum Benefit up to $25,000
Medical Evacuation Maximum Lifetime Benefit for all Evacuations up to $100,000
Bedside Visit Up to a maximum benefit of $750 for the cost of one economy round trip airfare ticket to, and the hotel accommodations in, the place of the Hospital Confinement for one (1) person

NOTE: Certain limitations and exclusions apply to each plan, which will be outlined in the Certificate of Coverage. HTH Worldwide plans conform to state statutes and therefore if any provision of the plan is in conflict with the statutes of the state in which the Insured Person resides on such date, the plan is hereby amended to conform to the minimum requirements of such state statutes. The benefits summarized above are underwritten by HM Life Insurance Company, Pittsburgh, PA, NAIC # 0812-93440 or HM Life Insurance Company of New York, New York, NY, NAIC # 0812-60213 under policy form series HM207-SI, HM207-TH or HM207-EH GC. The coverage requested may not be available in all states.

This web page describes the benefits under the plan of insurance. This is not a contract of insurance. Coverage is governed by an insurance policy issued to Global Citizen Association underwritten by HM Life Insurance Company, Pittsburgh, PA, NAIC # 0812-93440 or HM Life Insurance Company of New York, New York, NY, NAIC # 0812-60213  under policy form HM207-SI, HM207-TH or HM207-EH GC.  The coverage requested may not be available in all states.  Complete information on the insurance is contained in the Certificate of Insurance, which will be provided to you as evidence of coverage under the policy.

Any provision of this plan as described that may be in conflict with the laws of the state where the purchaser is located will be administered to conform to the requirements of that state’s laws, including mandated state benefits. Therefore, Participants may be entitled to additional benefits.