- Maximum per sickness/injury:
$100,000
-
Co-insurance in network:
80%
- Co-insurance out-of-network:
60%
- Out of pocket in network:
Unlimited
- Co-pay in ER (waived if admitted):
$350
- Co-pay in SHC:
$5
- Co-pay specialist visit:
$50
- Co-pay hospitalization:
$0
- Co-pay in Urgent Care:
$50
- Co-pay office visit:
$50
- Pre-existing condition waiting period:
N/A
- Preventative care:
Direct-billing
- Medical evacuation & repatriation:
80% UCR-Up to $50,000
- Medical evacuation:
80% UCR-Up to $50,000
- Repatriation:
80% UCR-Up to $25,000
- Rating base:
Daily
- Premium:
$25.1/Month
- Maximum per sickness/injury:
$500,000
-
Co-insurance in network:
90%
- Co-insurance out-of-network:
70%
- Out of pocket in network:
Unlimited
- Co-pay in ER (waived if admitted):
$250
- Co-pay in SHC:
$5
- Co-pay specialist visit:
$50
- Co-pay hospitalization:
$0
- Co-pay in Urgent Care:
$50
- Co-pay office visit:
$50
- Pre-existing condition waiting period:
N/A
- Preventative care:
Direct-billing
- Medical evacuation & repatriation:
90% UCR-Up to $50,000
- Medical evacuation:
90% UCR-Up to $50,000
- Repatriation:
90% UCR-Up to $25,000
- Rating base:
Daily
- Premium:
$48.3/Month