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Liaison Student

International Student Health Insurance

Benefits Economy Choice Elite
Lifetime Medical Maximum $5,000,000
Maximum Benefit options
Per injury/illness $100,000; $250,000; $500,000; $1,000,000
Deductible options
Per injury/illness $0, $50, $100, $250, $500, $1,000
Student Health Center
Copay per visit
*not subject to the deductible
$5
Coinsurance
In-network, inside the US 80% of expenses up to $5,000, then 100% up to the Medical Maximum 90% of expenses up to $5,000, then 100% up to the Medical Maximum 100% of expenses up to the Medical Maximum
Out-of-network, inside the US 70% of expenses up to $5,000, then 100% up to the Medical Maximum 80% of expenses up to $5,000, then 100% up to the Medical Maximum 90% of expenses up to $5,000, then 100% up to the Medical Maximum
Outside the US 100% up to the medical maximum
Subject to deductible and coinsurance unless otherwise stated
Hospital Services
Hospital Room & Board Up to Medical maximum
Inpatient Up to Medical maximum
Outpatient Up to Medical maximum
Emergency Room Up to Medical maximum
Doctor Office Visits Up to Medical maximum
Coma Benefit
*separate from the Medical Maximum
$10,000 $25,000 $50,000
Local Ambulance
Inside the US $350 per Displacement $500 per Displacement $750 per Displacement
Outside the US Up to Medical maximum
Prescription Drugs
Inside the US
*not subject to Deductible
$10 Copay for generic; $20 Copay for brand name $5 Copay for generic; $10 Copay for brand name $0 Copay
Outside the US $0 Copay, deductible applies
Vaccinations
In the US only, as required by school, University or Visa program $100 per 364 days of continuous coverage $150 per 364 days of continuous coverage $200 per 364 days of continuous coverage
Mental Health Includes Alcohol & Substance Abuse
Outpatient Treatment
Maximum 45 days
80% up to $500 80% up to $1,000 100% up to $2,000
Inpatient Treatment
Maximum 45 days
Up to $5,000 Up to $10,000 Up to $20,000
Emergency Dental Treatment
Due to an accident $500 maximum $1,000 maximum $2,500 maximum
Alleviate onset of pain $150 maximum $250 maximum $350 maximum
Pre-existing Conditions
Coverage for pre-existing conditions Up to Medical Maximum After
12-month waiting period
Acute Onset of a pre-existing condition
Inside the US
$5,000 maximum for eligible expenses for the acute onset of pre-existing condition only $10,000 maximum for eligible expenses for the acute onset of pre-existing condition only $25,000 maximum for eligible expenses for the acute onset of pre-existing condition only
Maternity
6-month waiting period
In-network, inside the US Up to $500 80% up to $10,000 80% up to $25,000
Out-of-network, inside the US Up to $500 60% up to $10,000 60% up to $25,000
Outside the US Up to $500 80% up to $10,000 100% up to $25,000
Benefits are reduced an additional 25% for failure to notify the company within the first 90 days of pregnancy
Newborn Care
Routine nursery care $250 maximum $500 maximum $750 maximum
High School, Interscholastic, intercollegiate, intramural or club sports
Only available for an exclusive list of covered sports. Please refer to the certificate at the end of the page. $2,500 $5,000 $10,000
Physical Therapy and Chiropractic Care
Physical Therapy $25 per day; 60 days max $50 per day; 60 days max $75 per day; 60 days max
Spinal Manipulation $25 per day; 60 days max when prescribed by a Physician $50 per day; 60 days max when prescribed by a Physician $75 per day; 60 days max when prescribed by a Physician
Incidental Home Country Coverage
Incidental Trips to Home Country: minimum purchase of 30 days $1,000 $5,000 $10,000
Extension of Benefits $1,000 $5,000 $10,000
Motor Vehicle Accident
Inside the US 50% up to $100,000 75% up to $100,000 100% up to $100,000
Outside the US Up to Medical Maximum
International Emergency Care
Emergency Medical Evacuation $100,000 $500,000 $750,000
Emergency Reunion Up to $200 per day/ $15,000 maximum limit Up to $200 per day/ $25,000 maximum limit Up to $200 per day/ $50,000 maximum limit
Return of Child(ren) $25,000 $40,000 $50,000
Return of Mortal Remains $50,000
Political Evacuation and Repatriation $10,000
Local Burial or Cremation $5,000
Natural Disaster
Evacuation $5,000 $10,000 $10,000
Daily Benefit $25 per day; 5 day limit $50 per day; 5 day limit $75 per day; 5 day limit
Accidental Death and Dismemberment
Primary Participant $25,000
Spouse $10,000
Child $5,000
Total for Insureds $250,000
Personal Liability $25,000 $50,000 $100,000
Additional Benefits
24/7 Travel Assistant Included
Non-contact Amateur Sports $2,500 $5,000 $10,000
Terrorism $25,000 $50,000 $100,000
Felonious Assault $10,000 $15,000 $20,000
Please note: The benefit table listed above is a consolidated version of the full plan benefits. Please view the plan certificates for the Liaison Student Medical Economy, Liaison Student Medical Choice, Liaison Student Medical Elite for the full benefits and limitations of the plan. Limits apply to all benefits.