Maximum Limit

$250,000

Deductible

$100 Per injury or illness
Additional $250 Deductible for non-admitted treatment of an illness in the ER.

Co-Insurance

The company will pay 100% of Usual Reasonable and Customary (URC) for Eligible Medical Expenses, after the deductible

Hospital Room & Board

Up to the Average Semi-private room Rate, including nursing service

Intensive Care Unit

Usual Reasonable and Customary

Physical Therapy

Usual Reasonable and Customary: Outpatient Benefits are limited to 1 visit per day

Physicians Visits

Usual Reasonable and Customary: Benefits are limited to 1 visit per day, not applicable to Surgery

Eligible Medical Expenses

Usual Reasonable And Customary

Student Health Center

$5 Co-pay per visit

Dental Treatment

Relief of sudden and unexpected pain to sound, natural teeth, including but not limited to fillings: Up to $300 Maximum
Injury: Up to $500 per Accident maximum, including fractures

Emergency Medical Evacuation Expenses

Up to $50,000 life time maximum Limit. Must be approved in advance and coordinated by the Company. Includes Return Home Benefit

Emergency Reunion

Up to $15,000 lifetime maximum Limit. Must be approved in advance and coordinated by the Company.

Return of Mortal Remains

Up to $25,000. Must be approved by the Company

Political Evacuation

Up to $10,000

Accidental Death And Dismemberment

For Accidental Death $25,000: for Dismemberment Scheduled amounts

Interscholastic Sports

Organized High School Sports coverage included: Professional Sports excluded

Baggage

Loss / Theft of Baggage $250.00
Loss / Theft of Valuables $250.00
Loss / Theft of Personal Papers $250.00

Legal Assistance Binder Fee

$500.00 if served with summons

Personal Liability

$2000.00 Maximum, subject to $100 deductible

Third Person Property Damage

$500.00 Maximum subject to $100 deductible. Secondary Coverage

Interscholastic Sports

Organized Sports coverage rider for High School Sports only. Professional and Intercollegiate Sports excluded.