Plan Features Global Care Basic - Visit International Global Care Intercollegiate Sports Plus - Visit International Global Care Plus - Visit International Global Care Preferred - Visit International
Eligibility All international students, scholars or other persons with a current passport who: 1) are engaged in educational activities; and 2) are temporarily located outside his/her home country as a non resident alien; and 3) have not obtained permanent residency status in the U.S. are eligible to enroll in this plan. Those enrolled in an English language or similar program or an Optional Practical Training Program or with an For J visa are also eligible to enroll in the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes tor at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program. All international students, scholars or other persons with a current passport who: 1) are engaged in educational activities; and 2) are temporarily located outside his/her home country as a non resident alien; and 3) have not obtained permanent residency status in the U.S. are eligible to enroll in this plan. Those enrolled in an English language or similar program or an Optional Practical Training Program or with an F or J visa are also eligible to enroll in the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes for at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program. All international students, scholars or other persons with a current passport who: 1) are engaged in educational activities; and 2) are temporarily located outside his/her home country as a non resident alien; and 3) have not obtained permanent residency status in the U.S. are eligible to enroll in this plan. Those enrolled in an English language or similar program or an Optional Practical Training Program or with an F or J visa are also eligible to enroll in the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes for at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program. All international students, scholars or other persons with a current passport who: 1) are engaged in educational activities; and 2) are temporarily located outside his/her home country as a non resident alien; and 3) have not obtained permanent residency status in the U.S. are eligible to enroll in this plan. Those enrolled in an English language or similar program or an Optional Practical Training Program or with an F or J visa are also eligible to enroll in the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes for at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program.
Maximum Benefit $500,000 (For each Injury or Sickness) No Overall Maximum Dollar Limit No Overall Maximum Dollar Limit No Overall Maximum Dollar Limit
Network Preferred Provider Out-of-Network Preferred Provider Out-of-Network Preferred Provider Out-of-Network Preferred Provider Out-of-Network
Deductible $100 (Waived at Student Health Center) $500 $100 Per Insured Person, Per Policy Year (Waived at Student Health Center) $300 $100 (Waived at Student Health Center) $300 $50 (Waived at Student Health Center) $300
Co-insurance 80% except as noted 70% except as noted 80% except as noted 70% except as noted 80% except as noted 70% except as noted 90% except as noted 70% except as noted
Out of Pocket Maximum $10,000 (Per Insured Person, Per Policy Year) N/A $6,350 (Per Insured Person, Per Policy Year). $12,700 (For all Insureds in a Family, Per Policy Year). $8,000 (Per Insured Person, Per Policy Year). $16,000 (For all Insureds in a Family, Per Policy Year). $6,350 (Per Insured Person, Per Policy Year). $12,700 (For all Insureds in a Family, Per Policy Year). $8,000 (Per Insured Person, Per Policy Year). $16,000 (For all Insureds in a Family, Per Policy Year). $5,000 (Per Insured Person, Per Policy Year). $10,000 (For all Insureds in a Family, Per Policy Year). $7,000 (Per Insured Person, Per Policy Year). $14,000 (For all Insureds in a Family, Per Policy Year).
Pre-existing Waiting Period 6 months None None None
INPATIENT INPATIENT INPATIENT INPATIENT INPATIENT
Room & Board/Hosp Misc: 80% Preferred Allowance/$100 Copay per Hospital Confinement 70% Usual and Customary Charges/$100 Deductible per Hospital Confinement 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 90% Preferred Allowance 70% Usual and Customary Charges
Routine Newborn Care (Max 4 Days): Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness
Surgery: 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 90% Preferred Allowance 70% Usual and Customary Charges
Physician's Visits: 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 90% Preferred Allowance 70% Usual and Customary Charges
Psychotherapy: Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness
OUTPATIENT OUTPATIENT OUTPATIENT OUTPATIENT OUTPATIENT
Surgery: 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 90% Preferred Allowance 70% Usual and Customary Charges
Physician's Visits: 80% Preferred Allowance /$30 Copay per visit 70% Usual and Customary Charges 80% Preferred Allowance/$25 Copay per visit 70% Usual and Customary Charges 80% Preferred Allowance/$25 Copay per visit 70% Usual and Customary Charges 90% Preferred Allowance/$20 Copay per visit 70% Usual and Customary Charges
Medical Emergency: 80% Preferred Allowance /$100 Copay per visit 70% Usual and Customary Charges /$100 Deductible per visit 80% Preferred Allowance/$200 Copay per visit 70% Usual and Customary Charges/$200 deductible per visit 80% Preferred Allowance/$200 Copay per visit 70% Usual and Customary Charges/$200 deductible per visit 90% Preferred Allowance/$150 Copay per visit 70% Usual and Customary Charges/$150 Deductible per visit
X-Rays & Laboratory 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 90% Preferred Allowance 70% Usual and Customary Charges
Prescription Drugs: UnitedHealthcare Pharmacy (UHCP) $20 Copay per prescription for Tier 1. 30% Coinsurance per prescription for Tier 2. 40% Coinsurance per prescription for Tier 3. Up to a 31-day supply per prescription ($2,500 maximum). UnitedHealthcare Pharmacy (UHCP) $15 Copay per prescription for Tier 1. 20% Coinsurance per prescription for Tier 2. 30% Coinsurance per prescription for Tier 3. Up to a 31 day supply per prescription. UnitedHealthcare Pharmacy (UHCP) $15 Copay per prescription for Tier 1. 20% Coinsurance per prescription for Tier 2. 30% Coinsurance per prescription for Tier 3. Up to a 31 day supply per prescription. UnitedHealthcare Pharmacy (UHCP) $15 Copay per prescription for Tier 1. $30 Copay per prescription for Tier 2. $50 Copay per prescription for Tier 3. Up to a 31 day supply per prescription.
Psychotherapy Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness
CAT/MRI 80% Preferred Allowance /$200 Copay per visit 70% Usual and Customary Charges /$200 Deductible per visit 80% Preferred Allowance/$150 Copay per visit 70% Usual and Customary Charges/$150 deductible per visit 80% Preferred Allowance/$150 Copay per visit 70% Usual and Customary Charges/$150 deductible per visit 90% Preferred Allowance/$100 Copay per visit 70% Usual and Customary Charges/$100 Deductible per visit
Urgent Care 80% Preferred Allowance /$50 Copay per visit 70% Usual and Customary Charges /$50 Deductible per visit 80% Preferred Allowance/$50 Copay per visit 70% Usual and Customary Charges/$50 deductible per visit 80% Preferred Allowance/$50 Copay per visit 70% Usual and Customary Charges/$50 deductible per visit 90% Preferred Allowance/$50 Copay per visit 70% Usual and Customary Charges/$50 Deductible per visit
Preventive Care Services (Per PPACA) 100% of Preferred Allowance, $1,000 Maximum Per Policy Year No Benefits 100% of Preferred Allowance No Benefits 100% of Preferred Allowance No Benefits 100% of Preferred Allowance No Benefits
OTHER OTHER OTHER OTHER OTHER
Ambulance: 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 80% Preferred Allowance 70% Usual and Customary Charges 90% Preferred Allowance 70% Usual and Customary Charges
Alcoholism/Drug Abuse: Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness
Maternity & Complications of Pregnancy Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness Paid as any other Sickness
Repatriation Benefits provided by UnitedHealthcare Global Benefits provided by UnitedHealthcare Global Benefits provided by UnitedHealthcare Global Benefits provided by UnitedHealthcare Global
Medical Evacuation Benefits provided by UnitedHealthcare Global Benefits provided by UnitedHealthcare Global Benefits provided by UnitedHealthcare Global Benefits provided by UnitedHealthcare Global
Intercollegiate Sports No Benefits No Benefits 80% Preferred Allowance/$10,000 Maximum for Each Injury 70% Usual and Customary Charges/$10,000 Maximum for Each Injury No Benefits No Benefits No Benefits No Benefits