Study USA-Healthcare-Basic

Plan Detail

Plan Administrator: USI Affinity Travel Insurance Services | AM Best Rating: A+ "Superior" | Underwriter: Lloyd's of London

Benefits


 

Basic

Overall Maximum Limit

$200,000

Maximum Injury or Illness

$100,000

Pre-Existing Condition Waiting Period

N/A

Deductible (except emergency room)

$100 in network/$150 out of network

ER Deductible

$500/incident

Coinsurance – Claims Incurred in the U.S.

 
  •  In-Network Payment

80% after the deductible, up to the overall maximum limit.

  • Out-of-Network Payment

Usual, reasonable, and customary (URC)

Coinsurance - Claims Incurred Outside the U.S.

100% after the deductible, up to the overall maximum limit.

Local Ambulance

$300 per injury/illness

Prescription Drugs

For outpatient prescriptions 50% of actual charges

Wellness

N/A

Physical Therapy & Chiropractic Care

$25 per visit per day.

Dental Treatment due to Accident

N/A

Mental Health Disorders

Outpatient: $50 max. per day, $500 max. Inpatient: Usual, reasonable and customary charges up to $5,000

Maternity Care for Covered Pregnancy

N/A

Intercollegiate, Interscholastic, Intramural or Club Sports

N/A

Dental Treatment to Alleviate Pain

N/A

Personal Liability

N/A

Repatriation of Remains

$25,000 lifetime max.

Terrorism

$50,000 lifetime max.

Accidental Death & Dismemberment

$10,000 lifetime max.

Emergency Reunion (Max. 15 days)

$1,500