| 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 |
| . Prescription |
$30 generic / $40 all other |
$60 |
| . ER visit (waived if admitted) |
$250 |
$3,000 |
| . 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 |
| 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
Your spouse and any dependent children are also eligible for coverage if accompanying you. Permanent residents are not
eligible for coverage under this Policy.