| Benefits |
In Network (PPO) |
Out of Network |
| Medical expense per accident/sickness |
$250,000 |
$250,000 |
 Lifetime
medical maximum |
No Maximum |
$1,000,000 |
| Deductible |
$0 |
$0 |
| Maximum out-of-pocket expenses1 |
$2,000 annually |
No Maximum |
| Co-insurance |
80% of first $4,000; 100% up to $250,000 of PPO Allowance |
70% of Reasonable and Customary charges up to $250,000 |
| Co-payment2 |
|
|
| . At student health center |
$0 |
$0 |
| . Elsewhere |
$40 |
$60 |
| . ER visit (waived if admitted) |
$250 |
$300 |
| . Hospitalization |
$250 |
$500 |
| Pre-existing condition |
Covered after 6 months |
Covered after 6 months |
| Maternity |
Covered as any other illness |
Covered as any other illness |
| Prescription |
$1,000 annually |
$1,000 annually |
| Prescription deductible per fill |
$30 |
$30 |
| X-ray and labs tests |
$2,000 annually |
$2,000 annually |
| Medical
evacuation |
$100,000 |
$100,000 |
| Repatriation
of remains |
$50,000 |
$50,000 |
| Accidental death & dismemberment |
$15,000 |
$15,000 |
| View policy brochure |
  |
|
1Not including co-payment
2Co-payments are waived if student is treated on site at student health center and is not referred
off campus.
- In case of a student not being able to be treated at health center, and subsequently referred to off campus private doctor,
co-payment will be half of scheduled amount.
- In case of treatment not being possible at student health center and student is referred to the ER, co-payment will be half
of scheduled amount.
- In case of treatment not being available at student health center and student is referred to the ER and then subsequently
hospitalized; ER, doctor's visit and hospitalization co-payments will be integrated to a maximum of $250 in PPO or $500 elsewhere.
Eligibility: You are eligible if you are a member of ISO
have a current passport or visa and are temporarily residing outside
your home country/country of permanent residence, while actively engaged in education or research activities. You are "actively
engaged" in educational activity if you are one of the following:
- F1/J1 valid visa holder
- Undergraduate - registered for and attending classes on a full time basis.
- Graduate student
- Scholar or researcher who is invited by an educational organization
- Student involved in education, educational activities, or research- related activities
- Students on OPT are not eligble for this plan
Your spouse and any dependent children are also eligible for coverage if accompanying you. Permanent residents are not
eligible for coverage under this Policy.