Collegiate Care Preferred
As an international, you are considered “actively engaged“ in education, teaching, or research activities if you are one of the following: F1/J1/H1 Visa holder; undergraduate registered for and attending classes on full time basis; graduate student; student involved in education, educational activities, or research related activities; scholar; researcher; or teacher who is invited by an educational organization.
For students to be eligible you must be actively attending classes for at least the first 31 calendar days after the date for which your coverage is purchased. Home study, correspondence, internet classes, and television courses do not fulfill the eligibility requirements of Collegiate Care Plans. You must be enrolled to cover your spouse and/or children. Permanent residents (green card holders) and US Citizens are not eligible for this Plan. It is only available for internationals while in the USA. Accidental Death Benefit – the plan pays $15,000 when your death occurs as a result of accidental Injury. Loss of life must result within 90 days of the date of the accident causing such loss. Your coverage under the Policy must be in force on the date of the accident and when loss of life occurs. Dismemberment Benefit - If you sustain accidental Injury that results in loss of a limb or sight the plan will pay the portion of the Principal Sum shown below. Loss must occur within 90 days of the accident causing such loss. In the event of more than one loss only one sum, the largest, will be paid. |
Plan Features:Medical Benefits:
This plan is designed for:
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Collegiate Care Preferred Plan Description
ELIGIBILITY
You are eligible for this coverage in the USA, if you 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 education, teaching or research activities 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; Students involved in education, educational activities, or research related activities. Students must actively attend classes for at least the first 31 calendar days after the date for which coverage is purchased. Home study, correspondence, internet classes and television courses do not fulfill the eligibility requirements. Your spouse and dependent children are also eligible for coverage if accompanying you and enrolled on your policy. For purposes of this insurance, if the Eligible Person’s home country or country of permanent residence (passport country) is different from the Eligible Person’s country of permanent residence (location in which the Eligible Person permanently resides), the Eligible Person will not be covered in either location. Permanent residents (green card holders) and US Citizens are not eligible for coverage under this Policy. Home Country will be that country which the Covered Person has declared to Us in writing as his or her Home Country. |
Coverage EFFECTIVE dates
Effective Date – The Effective Date of this Policy is the later of the following: 1. the date the Company receives a completed Application and correct premium for the Period of Insurance, or 2. the date requested on the Application, or 3. the day after applying online, or 4. the day after postmark when mailed. The Effective Date for your eligible spouse or dependents enrolled with you is your Effective Date, provided the Company receives the required premium for the spouse or dependent. If a spouse or dependent becomes eligible after your Effective Date, you have 30 days from the date such spouse or dependent first becomes eligible to enroll them and pay the applicable premium. Coverage Ends - Your coverage ends on the earliest of the following: 1. the date you cease to be eligible for coverage; or 2. the end of your term of coverage; or 3. the date requested on your application; or 4. the last day for which premium has been paid; 5. The date you no longer are affiliated with a school; 6. The date you return home; 7. After 364 consecutive covered days. Your spouse or dependent coverage will end at the earliest of: 1. the end of your term of coverage; or 2. the date requested on your application; or 3. the last day for which premium has been paid; 4. The date you no longer are affiliated with a school; 5. The date you return home; 6. After 364 consecutive covered days; or 7. the date a spouse or dependent is no longer eligible for coverage. - Your coverage ends on the earliest of the following: 1. the date you cease to be eligible for coverage; or 2. the end of your term of coverage; or 3. the date requested on your application; or 4. the last day for which premium has been paid; 5. The date you no longer are affiliated with a school; 6. The date you return home; 7. After 364 consecutive covered days. Your spouse or dependent coverage will end at the earliest of: 1. the end of your term of coverage; or 2. the date requested on your application; or 3. the last day for which premium has been paid; 4. The date you no longer are affiliated with a school; 5. The date you return home; 6. After 364 consecutive covered days; or 7. the date a spouse or dependent is no longer eligible for coverage. |
Medical expense benefits
Preferred - $3,000,000 Annual Maximum for all Medical Expense
Per Injury or Sickness Student: $500,000 Spouse/Domestic Partner: $100,000 Dependent Child: $100,000
The plan will pay benefits for covered expenses incurred by you for loss due to Sickness or injury, less any per injury or sickness deductible and subject
to the Schedule: 1. The Maximum benefit for all services as shown in the Eligible Medical Expenses Section; 2. The Maximum amount for specific services
as shown in the Schedule; and 3. Any coinsurance amount shown in the Schedule. Covered expenses are considered incurred when the covered service
is rendered, provided there is a charge made for such service. The plan provides payment for services, procedures and supplies that are medically
necessary. No benefits will be paid for expenses determined not to be medically necessary, including any or all days of hospital stay. The total payable
for all covered expenses will not exceed the Maximum benefit shown in the Schedule; 13 weeks of treatment or to the end of the Period of Insurance,
whichever comes first. |
Eligible medical expenses
: 1. Physician Visit Benefit Inpatient -We will pay charges by a Physician for other than pre- or post-operative care for in-Hospital visits, for Physician’s Visit – In-Hospital, unless it is covered through an all-inclusive case rate negotiated through the network. Outpatient - $0 Student Health Center Co-Pay $30 per visit Co-Pay and after the Co-Pay We will pay charges by a Physician for office visits, up to the Maximum. 2. Specialist Outpatient Visit Benefit $50 per visit Co-Pay and after the Co-Pay We will pay charges by a Physician for office visits, up to the Maximum. 3. Consultant Physician Benefit When requested and approved by the attending physician $50 Co-Pay if, by reason of Injury or Sickness a Covered Person requires the services of a Consultant or Specialist when they are deemed necessary and ordered by an attending Physician for the purpose of confirming or determining a diagnosis. We will pay the amount incurred unless the cost of this service is included in a negotiated case rate with the provider or facility. 4. Hospital Room & Board Benefit Semi-Private Room Rate max 30 days and $250 Inpatient Co-Pay and $250 Outpatient Co-Pay. 5. ICU Room and Board Benefit We will pay charges for each day of Intensive Care/Cardiac Care Unit confinement. 6. Hospital Miscellaneous Expense Benefit Inpatient - We will pay for services, supplies and charges during a Hospital Stay. Miscellaneous services include services and supplies such as: the cost of the operating room; laboratory tests; X-ray examinations; anesthesia; drugs (excluding take-home drugs) or medicines; therapeutic services; and supplies; and blood and blood transfusions. Outpatient-We will pay for services and supplies such as: the cost of the operating room; laboratory tests; X-ray examinations; anesthesia; drugs or medicine; therapeutic services; and supplies, on an Outpatient basis. 7. Surgeon/Surgery In or Outpatient Benefit $30 Surgeon PCP Co-Pay or $50 Co-Pay for Specialist. We will pay charges for a Physician, for primary performance of a surgical procedure. 8. Assistant Surgeon Benefit If, in connection with such operation, a Covered Person requires the services of an Assistant Surgeon, We will pay the Covered Expense incurred. 4 COLLEGIATE CARE 9. Emergency Room Benefit $250 per visit Co-Pay. We will pay if the Covered Person requires Emergency Room treatment due to a Covered Loss resulting directly and independently of all other causes from a Covered Accident or Sickness. 10. Pre-Admission Testing Benefit We will pay benefits for charges for Pre admission testing (inpatient confinement must occur within 3 days of the testing. 11. Anesthesia Benefit We will pay benefits for Anesthesia for pre-operative screening and administration of anesthesia during a surgical procedure whether on an Inpatient or Outpatient basis. 12. Diagnostic X-Ray and Laboratory Benefit We will pay if the Covered Person requires diagnostic x -ray and/or laboratory examinations and services due to a Covered Loss. 13. Physiotherapy/Chiropractic Expense Benefit Charges include treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, microtherm, chiropractic, adjustments, manipulation, acupuncture, or any form of physical therapy. 14. Ambulance Benefit When, by reason of Injury or Sickness, a Covered Person requires the use of a community or Hospital Ambulance in a Medical Emergency, We will pay up to $350 for transportation, within the metropolitan area in which the Covered Person is located at that time the service is used. 15. Mental and Nervous Conditions Expense Benefit If a Covered Person requires treatment for a Mental or Nervous Condition, We will pay for such treatment as follows: Benefits for Inpatient Hospital Confinement -When a Covered Person requires Hospital Confinement for treatment of a Mental or Nervous Condition. Benefits for Outpatient Services - We will pay the Eligible Expenses incurred for the Outpatient treatment of a Mental and Nervous Condition. 16. Alcohol and Drug Abuse Expense Benefit If a Covered Person requires treatment on account of alcoholism, Alcohol Abuse, Drug Abuse or drug dependency, We will pay for such treatment as follows: Benefits for Inpatient Hospital Confinement - When a Covered Person is confined as an inpatient in: (i) a Hospital; or (ii) a Detoxification Facility for the treatment of alcoholism, Alcohol Abuse, Drug Abuse or drug dependency. Benefits for Outpatient Services -Treatment and Physician services include charges for services rendered in a Physician’s office or by an Outpatient treatment department of a Hospital. 17. Emergency Dental Expense Benefit We will pay for expenses for emergency dental treatment due to Injury to Natural Teeth or to relieve pain. 18. Outpatient Prescription Drug Benefit 100% - Pay and claim 19. Durable Medical Equipment Expense Benefit If, by reason of Injury or Sickness, a Covered Person requires the use of Durable Medical Equipment, We will pay the Eligible Expenses incurred by a Covered Person for such Durable Medical Equipment. We pay the Eligible Expenses incurred by a Covered Person for the purchase or rental of such item. 20. Emergency Medical Evacuation and Return of Remains Benefit When You suffer loss of life for any reason or incur a covered Sickness or Injury during the course of Your Period of Insurance, the following benefits are payable. Emergency Medical Evacuation: If the local attending Legally Qualified Physician and the Program Medical Advisor authorized travel assistance company determine that transportation to a Hospital or medical facility is Medically Necessary to treat an unforeseen Sickness or Injury which is acute or life threatening and adequate Medical Treatment is not available in the immediate area, the Transportation Expense incurred will be paid for the Usual and Customary Charges for transportation to the closest Hospital or medical facility capable of providing that treatment. Medical Repatriation: If the local attending Legally Qualified Physician and the authorized travel assistance company determine that it is Medically Necessary for You to return to Your primary place of residence because of an unforeseen Sickness or Injury which is acute or life-threatening, the Transportation Expense incurred within 30 days from the date of the Covered Loss, will be paid for Your return to Your primary place of residence or to a Hospital or medical facility closest to Your primary place of residence capable of providing continued treatment. Return of Remains: In the event of Your death during the Period of Insurance, the expense incurred within 30 days from the date of the Covered Loss will be paid for minimally necessary casket or air tray, preparation and transportation of Your remains to Your primary place of residence. 21. Emergency Reunion - $10,000 If You are traveling alone and will be hospitalized for more than 7 consecutive days and Emergency Evacuation or Medical Repatriation is not imminent, benefits will be paid to transport one person, chosen by You, by Economy Transportation, for a single visit to and from Your bedside. Reasonable travel and accommodation expenses incurred in relation to the Emergency Medical Reunion for hotel and meals to a Maximum of $50 per day up to the Maximum stated. COLLEGIATE CARE 5 22. Maternity After a 12 month waiting period and conception must occur after the waiting period and while covered on the plan. The LMP is used to determine the date of conception. The Company will pay the Usual, Reasonable and Customary medical expenses in excess of the Deductible and Coinsurance as stated in the Schedule of Benefits, Maternity. Any newborn child must be enrolled in the coverage within 30 days of birth. |
Outpatient covered expense include:
. Surgery Services: • Surgeon • Anesthetist • Miscellaneous for Day Surgery benefits will be paid for services and supplies such as: the cost of the operating room; laboratory tests; X-ray examinations; anesthesia; drugs or medicine; therapeutic services; and supplies. 2. Miscellaneous Hospital and Doctor Surgery Services 3. Doctor’s Visits 4. Physiotherapy 5. Medical Emergency 6. Diagnostic X-ray Services - Separate maximums apply to positive and negative X-rays. Diagnostic X-rays are only those procedures identified in (CPT) as codes 70000-79999 inclusive. 7. Radiation Therapy 8. Laboratory Procedures - are only those procedures identified in Physicians’ Current Procedural Terminology (CPT) as codes 80000 - 89999 inclusive. 9. Tests and Procedures - a. Diagnostic services and medical procedures; b. Performed by a doctor; c. Excluding Doctor’s Visits; Physiotherapy; Xrays; and Laboratory Procedures. 10. Injections - a. When administered in the doctor’s office; and b. Charged on the doctor’s statement. 11. Prescription Drugs - Pay and claim. 12. Chemotherapy 13. Mammography – one per year 14. Pap Smear for annual testing performed by FDA-approved gynecologic cytology screening technologies. 15. Maternity the date of the last menstrual period will determine the date of the loss. 16. Alcohol and Substance Abuse 17. Mental and Nervous Disorders 18. Durable Medical Equipment (DME) |
Other services & Additional covered services
C. Other Services Include: 1. Ambulance Services – up to $350 per sickness or injury 2. Braces and Appliances: a. When prescribed by a doctor; and b. When a written prescription accompanies the claim when submitted. Braces and appliances include durable medical equipment which: Is primarily and customarily used to serve a medical purpose, Can withstand repeated use, and Is not generally useful to a person in the absence of sickness or injury. No benefits will be paid for rental charges in excess of purchase price. 3. Consulting Physician when requested and approved by the attending doctor. Covered expenses will be paid under this benefit or under the Doctor’s Visits benefit, but not both on the same day. 4. Dental Treatment performed by a doctor and made necessary by injury or to relieve pain to natural teeth. D. Additional Covered Services Include: 1. Repatriation - The plan pays for repatriation up to $50,000 while covered under the policy. This benefit will be paid for preparing and transporting your remains to your Home Country. 2. Emergency Medical Evacuation – the plan pays up to $50,000 for medical evacuation to your Home Country while you are covered under the policy. This benefit will be paid: a. During a minimum hospital stay; and b. When recommended and approved by the attending doctor. 3. Emergency Reunion - When an Insured Person is hospitalized for more than 7 days, and the Insured Person is eligible for a covered Emergency Medical Evacuation or Repatriation under this Policy, the Company will arrange and pay for round trip economy-class transportation for one individual selected by the Insured Person, from the Insured Person’s current Home Country to the location where the Insured Person is hospitalized and return to the current Home Country. 4. Home Country Coverage - Available after 30 days after the Effective date. Up to 30 days or $1000 whichever comes first. |
Accidental death & Dismemberment principal sum
Accidental Death Benefit – the plan pays $15,000 when your death occurs as a result of accidental injury. Loss of Life must occur within 90 days of the accident causing such loss. Your coverage must be in force on the date of the accident when loss of life occurs. 6 COLLEGIATE CARE Dismemberment Benefit - If you sustain accidental injury that results in loss of a limb or sight the plan will pay the portion of the Principal Sum shown below. Loss must occur within 90 days of the accident causing such loss. In the event of more than one loss only one sum, the largest, will be paid. For injury resulting in the loss of: • Both hands or both feet or the sight of both eyes ;or One hand and one foot, one hand or one foot and the sight of one eye: $15,000 • One hand or one foot or the sight of one eye: $7,500 “Loss of hand or foot” means severance at or above the wrist or ankle joint. “Loss of sight” must be entire and irrecoverable. |
exclusions
Pre-Existing Conditions The “Pre-existing Condition Waiting Period” is 6 months. If you receive treatment or service for a Pre-Existing Condition: a) No benefits will be paid for such condition until the day after a 6 consecutive month period has passed from your effective date; and b) The plan will pay only for Covered Expenses incurred after such 6 consecutive month period. Exclusions No benefits will be paid for loss or expense caused by or resulting from: 1. Suicide, attempted suicide (including drug overdose) self-destruction, attempted self- destruction or intentional self-inflicted Injury while sane or insane; 2. War or any act of war, declared or undeclared; 3. Injury sustained while in the service of the armed forces of any country; 4. Voluntary active participation in a riot or insurrection; 5. Medical expenses resulting from a motor vehicle accident in excess of that which is payable under any other valid and collectible insurance; 6. Treatment for an Injury or Sickness resulting from the Covered Person’s intoxication or use of illegal drugs or any drugs or medication that is intentionally not taken in the dosage recommended by the manufacturer or for the purpose prescribed by the Covered Person’s Physician; 7. Commission or attempt to commit an assault or felony, or that occurs while being engaged in an illegal occupation; 8. Eligible Expenses for which the Covered Person would not be responsible in the absence of the Policy; 9. Treatment of acne; 10. Charges which are in excess of Usual, Reasonable and Customary charges; 11. Charges that are incurred outside of the Period of Insurance either prior to coverage commencing or after coverage has terminated; 12. Charges that are not Medically Necessary; charges provided at no cost to the Covered Person; 13. Expenses incurred for treatment while in Your Home Country which exceed 30 days or $1000; 14. Expenses incurred for an Accident or Sickness after the termination date of coverage; 15. Regular health checkups, routine physical examinations, immunizations or other examinations where there are no objective indications or impairment in normal health; 16. Injuries paid under Workers’ Compensation, Employer’s liability laws or similar occupational benefits or while engaging in an occupation for monetary gain from sources; 17. Pre-existing conditions; however a Pre-Existing condition will be covered after the Covered Person has been continuously insured for 12 months under the same insurance plan; 18. Unless covered herein, Pregnancy or childbirth, elective abortion, or any complications of any of these conditions; 19. Dental care or treatment other than care of sound Natural Teeth and gums, required for Injury resulting from an Accident while covered under the Policy, and rendered within 6 months of the Accident; 20. Eyeglasses, contact lenses, hearing aids, braces, appliances, or examinations or prescriptions thereof; 21. Travel in or upon a snowmobile, a water jet ski, any two or three wheeled motor vehicle, motorcycle registered for on-road travel, or any off road motorized vehicle not requiring licensing as a motor vehicle; 22. Injury sustained while taking part in: mountaineering; hang gliding; parachuting; bungee jumping; racing by horse, motor vehicle or motorcycle; snowmobiling; motorcycle/motor scooter riding; scuba diving involving underwater breathing apparatus; snorkeling; water skiing; snow skiing; spelunking; parasailing; white water rafting; surfing, unless part of a school credit course; and snowboarding; or other hazardous activities as determined by the insurance company; 23. Practice or play in any amateur, club, intramural, interscholastic, intercollegiate, professional or semiprofessional sports, contest or competition; 24. Rest cures or custodial care; 25. Elective or Cosmetic surgery and Elective Treatment or treatment for congenital anomalies (except as specifically provided), except for reconstructive surgery on a diseased or injured part of the body. Correction of a deviated nasal septum is considered Cosmetic Surgery unless it results from a covered Injury or Sickness. |
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