Student Express Plan 2

Plan Detail

Plan Administrator: Seven Corners | AM Best Rating: A "Excellent" | Underwriter: Lloyd's

Benefits


Schedule of Benefits

All benefits below are shown in U.S. Dollar amounts.

Lifetime Medical Maximum
All Insured Persons $5,000,000
Per Injury/Illness Maximum
U.S. Citizens
Plans A & B $50,000 All Insured Persons
Plans C & D $100,000 All Insured Persons
Plans E, F, I, J $250,000 All Insured Persons
Plans G & H $500,000 All Insured Persons
Non-U.S. Citizens
Plan K $50,000 All Insured Persons
Plan L $100,000 All Insured Persons
Plans M & O $250,000 All Insured Persons
Plans N $500,000 Plan Insured Persons;
$100,000 Spouse/Dependent
Deductible Per Injury/Illness
U.S. Citizens
Plan B, D, F, H, J $0
Plan A, C, E, G, I $50
Non-U.S. Citizens
Plan K, M, N, O $100
Plan L $50

All Plans: Student Health Center: $5 per visit; not subject to deductible

Copay per Prescription Medicine
U.S. Citizens
Plan A, B, C, D, E, F, G, H, I, J $0 generic & $0 brand name
Non-U.S. Citizens
Plan K, L, M, N, O $10 generic & $20 brand name
Coinsurance
U.S. Citizens
Plan A, B, C, D, E, F, G, H 100% to plan maximum
Plan I, J 80% to plan maximum
Non-U.S. Citizens
Plan K, L, M, N 100% to plan maximum
Plan O 80% to plan maximum
Dental Accident Coverage $500 per accident
Emergency Medical Evacuation $100,000
Emergency Medical Evacuation for Acute Onset of a Pre-existing Condition $25,000
Return of Mortal Remains $50,000
Local Cremation or Burial $5,000
Emergency Medical Reunion $15,000 lifetime maximum
Political Evacuation $10,000 lifetime maximum
Terrorism $50,000 lifetime maximum
Ambulance Service per injury/illness maximum
Mental Illness
Inpatient 50% to $10,000, to a max of 45 days
Outpatient 80% to $500
Alcohol and Drug Abuse 50% up to $1,000
Injuries from a Motor Vehicle Accident
U.S. Citizens
Plan A, B, C, D, E, F, G, H, I, J per injury/illness maximum
Non-U.S. Citizens
Plan K $50,000 (not J visa compliant)
Plan L, M, N, O $100,000
Noncontact Amateur Sports
(includes high school, interscholastic, intramural, or club sports)
$5,000
Home Country Coverage
Incidental Trips to the Home Country $1,000
Home Country Extension of Benefits $1,000
Physiotherapy $25 max per day
Spinal Manipulation $25 max per day
Acute Onset of a Pre-ExistingCondition $25,000
Personal Liability $100,000
Accidental Death & Dismemberment (AD&D) $25,000 principal sum per plan Insured Persons and eligible dependent
Benefit Period Corresponds with your Period of Coverage

Medical Coverage

We cover injuries and illnesses which occur during your coverage period. Benefits are paid in excess of your deductible and coinsurance, up to your medical maximum. Initial treatment must occur within 30 days of your injury or the onset of your illness.

Emergency Medical Evacuation*

If medically necessary, we will:

1. Transport you to adequate medical facilities.

2. Transport you home after receiving medical treatment related to a medical evacuation.

Return of Remains*

We will return your remains to your home country if you should die while traveling. If this benefit is utilized, the local cremation/burial benefit will not apply.

Local Cremation Or Burial*

We will pay for preparation, local burial or cremation at the place of death, in accordance with your cultural and religious beliefs. If this benefit is utilized, the Return of Remains benefit will not apply.

Emergency Medical Reunion*

If you require an emergency medical evacuation, we will send one person of your choice to be at your side while you are hospitalized.

Political Evacuation*

If a formal recommendation is made for you to leave your host country, we will transport you to your home country. This benefit will not apply if a formal Travel Warning is in effect on or within 6 months prior to your arrival in your host country.

Terrorism

If you are injured as a result of terrorist activity, we will provide benefits if the following conditions are met:

1. You have no direct or indirect involvement.

2. The terrorist activity is not in a country or location where the U.S. Department of State or similar government organization of your home country has issued a travel warning within 6 months prior to your arrival date.

3. You have not unreasonably failed or refused to depart a country or location following the date a warning is ssued by the U.S. Department of State or similar government organization of your home country.

Mental Illness

Inpatient care includes: 1) hospital charges for room and board, nursing, and other medical services; 2) diagnosis and treatment by a physician; 2) cost and administration of anesthetics; 4) medication, x-rays, laboratory tests and services, oxygen, and medical treatment; 5) drugs and medicines that can only be obtained with a written prescription from a physician.

Outpatient care includes: 1) diagnosis and treatment by a physician; 2) cost and administration of anesthetics; 3) medication, x-rays, laboratory tests and services, oxygen, and medical treatment; 4) drugs and medicines that can only be obtained with a written prescription from a physician.

Noncontact Amateur Sports

Covered Sports are: tennis, squash, ultimate frisbee, kickball, volleyball, track & field, water-polo, baseball, basketball, aerobics, dancing, sailing, sea kayaking/canoeing, horseback riding, surfing, snow skiing, snowboarding, roller skating, rollerblading, and swimming.

Personal Liability

We will pay for eligible court-entered judgments or settlements (settlements must be approved by us) that are related to the personal liability you incur for acts, ommissions, and other occurrences for losses or damages caused by your negligent acts or omissions that result in: 1) injury to a third person; 2) damage or loss to a third person’s personal property; 3) damage or loss to a related third person’s personal property.

Accidental Death & Dismemberment (AD&D)

Pays benefits for death, loss of limbs, or loss of sight due to an accident occurring while on your trip.

Home Country Coverage

INCIDENTAL TRIPS - Provides up to 30 days of coverage for an illness or injury which occurs in your home country while you are on an incidental trip.

EXTENSION OF BENEFITS - Covers expenses incurred in your home country for conditions first diagnosed and treated outside your home country. All expenses must be incurred within 30 days of your return to your home country.

Acute Onset Of A Pre-existing Condition & Emergency Medical Evacuation For Acute Onset Of A Pre-existing Condition

You are covered for an acute onset of pre-existing conditions that occur after your coverage start date and while you are outside your home country if you receive treatment within 24 hours of the sudden and unexpected recurrence. Coverage is available for eligible medical expenses until the condition is no longer acute or you are discharged from the hospital. This benefit covers one acute episode per pre-existing condition. It also covers emergency medical evacuation as shown in the schedule. This benefit does not cover known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to your period of coverage.

An Acute Onset of a Pre-existing Condition is a sudden and unexpected outbreak or recurrence of a pre-existing condition which occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms. A pre-existing condition that is a congenital condition or that gradually becomes worse over time will not be considered an acute onset. A pre-existing condition will not be considered an acute onset if during the 30 days prior to the acute event you had a change in prescription or treatment for a diagnosis related to the acute event. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the coverage start date.

What is a Pre-existing Condition? It is any medical condition, sickness, injury, illness, disease, mental illness, or mental nervous disorder, regardless of the cause, including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time during the 12 months prior to the coverage start date of this policy, whether or not previously manifested, symptomatic, known, diagnosed, treated, or disclosed. This specifically includes but is not limited to any medical condition, sickness, injury, illness, disease, mental illness, or mental nervous disorder, for which medical advice, diagnosis, care, or treatment was recommended or received or for which a reasonably prudent person would have sought treatment during the 12 months immediately preceding the coverage start date of this policy.

Benefit Period

Your benefit period is the amount of time you have to receive treatment for a covered injury or illness. It corresponds with the period of coverage you purchased and ends when you coverage ends.

Refund Of Premium

We will provide a refund of your plan cost if we receive a written request from you prior to your coverage start date. If we receive your written request after your coverage start date, the unused portion of your plan cost may be refunded minus a cancellation fee if you have not submitted any claims.