DIANins · International Student Health Plans
Blue 80 CA / 90 CA / 100 CA Comparison
Blue CA is the California (ACA-style) version derived from the Blue plan, offered in three tiers by coinsurance — Blue 80 CA (80%), 90 CA (90%), 100 CA (100%). It adds ACA-required benefits such as rehabilitation, organ transplant, pediatric dental/vision, allergy testing, and HIV screening, and uses an OOPM structure where the deductible, copays, and coinsurance all accrue toward the maximum. U.S. network is Aetna.
Blue 80 CA: The lowest-premium tier. The insurer pays 80% of claims (you pay 20%), with the highest deductible and OOPM. Best for students prioritizing a lower premium.
Blue 90 CA: The middle tier. The insurer pays 90% (you pay 10%), with a mid-level deductible and OOPM. A balance of premium and coverage.
Blue 100 CA: The top tier. After the deductible, the insurer pays 100% of In-Network claims, so your out-of-pocket cost is lowest. With the lowest deductible ($0) and OOPM, it suits students wanting predictable costs.
✓ Covered ✗ Not covered orange text = has a cap CA CA-added benefits (ACA) ◆ best in this row
| |
Blue 80 CA80% Coinsurance |
Blue 90 CA90% Coinsurance |
Blue 100 CA100% Coinsurance |
| Core Benefits |
| DeductibleIn-Network |
$500 |
$100 |
$0 ◆ |
| DeductibleOut-of-Network |
$750 |
$500 |
$200 ◆ |
| Maximum per policy year |
UnlimitedUnlimited |
UnlimitedUnlimited |
UnlimitedUnlimited |
| Out-of-pocket maximumIn-Network |
$8,000OON $16,000 |
$7,000OON $14,000 |
$6,000 ◆OON $12,000 |
| CoinsuranceIn-Network |
80%OON 70% |
90%OON 70% |
100% ◆OON 70% |
| Pre-existing condition |
No waitStudent & Dependents |
No waitStudent & Dependents |
No waitStudent & Dependents |
| Vaccine & Physical Exam |
✓In-Net 100% |
✓In-Net 100% |
✓In-Net 100% |
| Copay — Office visitPhysician / Specialist |
$25 |
$25 |
$25 |
| Copay — ERwaived if admitted |
$150 |
$150 |
$150 |
| Copay — SHC / Urgent CareSHC / Urgent Care |
$0 / $50 |
$0 / $50 |
$0 / $50 |
| Prescription Drugs |
$10 / $30 / $50Tier 1 / 2 / 3 |
$10 / $30 / $50Tier 1 / 2 / 3 |
$10 / $30 / $50Tier 1 / 2 / 3 |
| Other Key Benefits |
| Hospitalization |
✓80% |
✓90% |
✓100% |
| ICU / Cardiac |
✓ |
✓ |
✓ |
| Surgical Benefits |
✓80% |
✓90% |
✓90% |
| Reconstructive Surgery |
✓ |
✓ |
✓ |
| Inpatient Rehabilitation |
✓80% |
✓90% |
✓100% |
| Maternity |
✓80% |
✓90% |
✓100% |
| Elective Abortion |
✓80% |
✓90% |
✓100% |
| Mental Health |
✓80% |
✓90% |
✓100% |
| Physical / Therapeutic |
✓80% |
✓90% |
✓100% |
| Cancer & Oncology |
✓80% |
✓90% |
✓100% |
| AIDS · HIV · STD |
✓80% |
✓90% |
✓100% |
| Alcohol / Substance |
✓80% UCR |
✓90% UCR |
✓100% UCR |
| Chiro / Acupuncture |
✓$500 |
✓$500 |
✓$500 |
| Home Health / Hospice |
✓80% |
✓90% |
✓100% |
| Organ / Transplant CA |
✓1 per lifetime |
✓1 per lifetime |
✓1 per lifetime |
| Congenital / Habilitative CA |
✓80% |
✓90% |
✓100% |
| Allergy / HIV Screening CA |
✓HIV screening 100% |
✓HIV screening 100% |
✓HIV screening 100% |
| Pediatric Dental / Vision CA |
✓Children only |
✓Children only |
✓Children only |
| Emergency Dental |
✓$250/tooth · $1,000 |
✓$250/tooth · $1,000 |
✓$250/tooth · $1,000 |
| Palliative Dental |
✓$600 |
✓$600 |
✓$600 |
| Recreational Sports |
✓80% |
✓90% |
✓100% |
| Evacuation / Repatriation |
✓100% |
✓100% |
✓100% |
| Excluded in all three tiers |
| Gender identity/dysphoria · cosmetic/elective surgery · infertility (IVF)/sterilization · vision correction·glasses·LASIK (except pediatric vision) · dental (except accidental/pediatric) · hearing aids · obesity/weight-loss treatment · smoking cessation · sleep studies (sleep apnea) · sexual dysfunction · genetic screening · breast reduction · travel immunizations · competitive/hazardous sports (varsity·club competition, skydiving, scuba beyond 30m, etc.)·motorcycles · war·terrorism · home-country care (beyond schedule) · care by a family member · costs reimbursable by other insurance/government |
How to choose a tier — important: All three tiers share identical covered benefits, caps, and exclusions; only the coinsurance rate, deductible, and OOPM differ. Blue CA is an ACA-style structure where the deductible, copays, and coinsurance all accrue toward the OOPM, so your costs clearly stop once the maximum is reached. Out-of-network is 70% for all three tiers.
Out-of-network OOPM is 2× the In-Network figure ($16,000 / $14,000 / $12,000).
Common: all four plans use the U.S. Aetna network, are issued by Spectrum Life, and use Global Reach Rx network pharmacies for prescriptions.
This table summarizes the Schedule of Benefits; final contract terms follow the official policy document.