COMPARE BENEFITS

 Apply Online  Download an Application (PDF)  Download a Brochure

 

Basic

Standard

Preferred 300

Preferred 500

Maximum Medical Limit

$200,000

$200,000

$300,000

$500,000

Maximum Injury or Illness

$100,000

$100,000

$300,000

$500,000

Pre‑Existing Condition Waiting Period

No coverage for pre-existing conditions

12 Months

12 Months

6 Months

Deductible
(except Emergency Room)

$100 per Injury or Illness with the Preferred Provider Organization or Student Health Center; otherwise $150 per Injury or Illness

$50 per Injury or Illness with the Preferred Provider Organization or Student Health Center; otherwise $150 per Injury or Illness

$45 per Injury or Illness with the Preferred Provider Organization or Student Health Center; otherwise $90 per Injury or Illness

$25 per Injury or Illness with the Preferred Provider Organization or Student Health Center; otherwise $50 per Injury or Illness

Emergency Room Deductible

$500 per incident

$350 per incident

$250 per incident

$100 per incident

Prescription Drugs

For outpatient prescriptions: 50% of actual charges

For outpatient prescriptions: $10 generic / $20 brand name

For outpatient prescriptions: $10 generic / $20 brand name

For outpatient prescriptions: $10 generic / $20 brand name

Wellness

N/A

100% of one routine physical exam per member

100% of one routine physical exam per member

100% of one routine physical exam per member

Physical Therapy & Chiropractic Care

$25 per visit per day. Must be ordered in advance by a physician and not obtained at a student health center.

$50 per visit per day. Must be ordered in advance by a physician and not obtained at a student health center.

$50 per visit per day. Must be ordered in advance by a physician and not obtained at a student health center.

$75 per visit per day. Must be ordered in advance by a physician and not obtained at a student health center.

Dental Treatment
(Due to Accident)

N/A

N/A

$1,000 maximum per certificate period

$1,000 maximum per certificate period

Dental Treatment
(to alleviate pain)

N/A

N/A

$100

$100

Mental Health Disorders (Excludes drug and alcohol abuse)

Outpatient: $50 maximum per day, $500 maximum. Inpatient: up to $5,000

Outpatient: $50 maximum per day, $500 maximum. Inpatient: up to $5,000

Outpatient: $50 maximum per day, $500 maximum. Inpatient: up to $10,000

80% in network; Out of network: Usual, reasonable and customary. Outpatient: Maximum of 30 visits. Inpatient: Maximum of 30 days.

Emergency Medical Evacuation

$50,000 lifetime maximum

$250,000 lifetime maximum

$500,000 lifetime maximum

$500,000 lifetime maximum

Accidental Death & Dismemberment

$10,000 lifetime maximum

$25,000 lifetime maximum

$25,000 lifetime maximum

$25,000 lifetime maximum

Repatriation of Remains

$25,000 lifetime maximum

$25,000 lifetime maximum

$25,000 lifetime maximum

$25,000 lifetime maximum

Maternity Care for Covered Pregnancy

N/A

80% in network. Out of network: usual, reasonable and customary.

80% in network. Out of network: usual, reasonable and customary.

80% in network. Out of network: usual, reasonable and customary.

Intramural, Intercollegiate, Interscholastic or Club Sports

N/A

$2,500 maximum per injury or illness, medical expenses only

$5,000 maximum per injury or illness, medical expenses only

$5,000 maximum per injury or illness, medical expenses only

Terrorism

$50,000 lifetime maximum

$50,000 lifetime maximum

$50,000 lifetime maximum

$50,000 lifetime maximum

Emergency Reunion

$1,500, subject to a maximum of 15 days

$2,500, subject to a maximum of 15 days

$2,500, subject to a maximum of 15 days

$5,000, subject to a maximum of 15 days