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GLOBAL STUDENT USA PREFERRED |
GLOBAL STUDENT USA |
| Coverages |
Limits - Covered Person
(No dependents allowed - No US Citizens)
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Limits - Covered Person
(No dependents allowed - No US Citizens)
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| MEDICAL BENEFITS |
| Lifetime Maximum Benefits |
$1,000,000 for Participant |
$1,000,000 for Participant |
| Policy Year Maximum Benefits |
$250,000 for Participant |
$250,000 for Participant |
| Maximum Benefit per Injury or Sicknesses |
$250,000 for Participant |
$250,000 for Participant |
| Basic Medical Expense Benefit per Injury or Sickness |
Up to $5,000 Maximum: 100% of Reasonable Expenses after Deductible. |
Up to $10,000 Maximum: 80% of Reasonable Expenses after Deductible. |
| Supplemental Major Medical Expense Benefit (SMM) per Injury or Sickness |
After Basic Medical Expense Benefit Maximum has been paid, 80% of Reasonable Expenses up to an additional $245,000 Maximum for Participant |
After Basic Medical Expense Benefit Maximum has been paid, 100% of Reasonable Expenses up to an additional $240,000 Maximum for Participant |
| Deductible |
$100 per Injury or Sickness - Deductible is reduced to $50 if treatment is received at Recognized Student Health Center or if initial treatment is received at Recognized Student Health Center. |
$100 per Injury or Sickness - Deductible is reduced to $50 if treatment is received at Recognized Student Health Center or if initial treatment is received at Recognized Student Health Center. |
| Physician Office Visits, Inpatient Hospital Services, Hospital and Physician Outpatient Services1 |
For Basic, after Deductible, 100% of Reasonable Expenses. For SMM Benefit, after Deductible, 80% of Reasonable Expenses.
For Inpatient Hospital Services - Maximum payment for Intensive Care Facilities up to $1,000 per day.
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For Basic, after Deductible, 80% of Reasonable Expenses. For SMM Benefit, after Deductible, 100% of Reasonable Expenses.
For Inpatient Hospital Services - Maximum payment for semi-private accommodations up to $500 per day and for Intensive Care Facilities up to $1,000 per day.
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| MEDICAL BENEFIT LIMITATIONS |
| Maternity Care for a Covered Pregnancy 2 |
Reasonable Expenses |
Reasonable Expenses |
| Inpatient treatment of mental and nervous disorders including drug or alcohol abuse |
Reasonable Expenses up to $5,000 Maximum per lifetime |
Reasonable Expenses up to $5,000 Maximum per lifetime |
| Outpatient treatment of mental and nervous disorders including drug or alcohol abuse |
Reasonable Expenses up to $500 Maximum per lifetime |
Reasonable Expenses up to $500 Maximum per lifetime |
| Treatment of Specified therapies, including acupuncture and Physiotherapy |
Reasonable Expenses for up $10,000 maximum per Injury or Sickness on an Inpatient basis. |
Reasonable Expenses for up $10,000 maximum per Injury or Sickness on an Inpatient basis. |
| Therapeutic termination of pregnancy |
Reasonable Expenses up to $500 per Policy Year |
Reasonable 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 |
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 |
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 |
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 |
Reasonable Expenses up to $350 per Injury or Sickness |
| Outpatient prescription drugs |
50% of actual charge |
50% of actual charge |
| Home Country Coverage (While Insured)3 |
100% of Reasonable Expenses up to $5,000 lifetime maximum |
100% of Reasonable Expenses up to $5,000 lifetime maximum |
| OTHER COVERAGES |
| Accidental Death & Dismemberment |
Maximum Benefit: Principal Sum up to $10,000 |
N/A |
| Repatriation of Remains |
Maximum Benefit up to $25,000 |
Maximum Benefit up to $25,000 |
| Medical Evacuation |
Maximum Lifetime Benefit for all Evacuations up to $100,000 |
Maximum Lifetime Benefit for all Evacuations up to $100,000 |
| Bedside Visit |
Up to a maximum benefit of $1,500 for the cost of one economy round trip air fare ticket to, and the hotel accommodations in, the place of the Hospital Confinement for one (1) person |
Up to a maximum benefit of $750 for the cost of one economy round trip air fare ticket to, and the hotel accommodations in, the place of the Hospital Confinement for one (1) person |
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PRE-EXISTING CONDITION LIMITATION4 |
The Insurer does not pay benefits for loss due to a Pre Existing Condition during the first one (1) year of coverage. This limitation does not apply to the Medical Evacuation Benefit, the Repatriation of Remains Benefit and to the Bedside Visit Benefit. |
- 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.
- 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.
- 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.
- Pre Existing Condition means any Injury or Sickness which had its origin or symptoms, or for which a Physician was consulted or for which treatment or a medication was recommended or received up to one (1) year prior to the Covered Person's effective date of coverage.
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