| Medical Coverage Schedule of Benefits |
USD
|
| Maximum per illness/injury |
$300,000 (Overall Maximum USD 1,000,000)
|
|
Coinsurance Percentages
|
Plan pays 100% of eligible charges
|
|
Outpatient copayment
|
$50
|
|
Hospital Services
|
|
|
Inpatient Room & Board
|
100% (URC) ¹
|
|
Intensive Care
|
100% (URC) ¹
|
|
Emergency Room Deductible (USA only)
|
For Injury: $0
For Illness resulting in direct hospitalization: $0
For Illness which does not result in direct hospitalization: $250
|
|
Outpatient Services
|
|
|
Physical Therapy
|
1 visit per day to a maximum of USD 2,500 / EUR 1.750 per Period of Insurance
|
|
Physician Visit
|
100% (URC) ¹
|
|
Prescription Drugs
|
100% (URC) ¹
|
|
Other Services
|
|
|
Eligible Medical Expenses
|
100% (URC) ¹
|
|
Durable Medical Equipment
|
100% (URC) ¹
|
|
Local Ambulance
|
Per Injury: 100% (URC) ¹
Per Illness (only if admitted Inpatient): 100% (URC) ¹
|
| Dental |
Sudden & Unexpected Pain: USD 200 / EUR 140 per Occurrence (limited to 3 x per Period of Insurance)
Accident exclusively involving dental treatment: USD 500 / EUR 350 per Period of Insurance
Major medical injury that also affects teeth: Medical benefits up to the Policy Limit
|
| Emergency Medical Evacuation |
Up to Maximum Limit |
| Emergency Reunion |
USD 15,000 / EUR 10.500 lifetime maximum benefit |
Urgent Travel Expense
(Compassionate Home Visit) |
Up to USD 1,000 / EUR 700 payable for transportation to Home Country in the event of death of a
close Family Member |
| Return of Mortal Remains |
Up to USD 25,000 / EUR 17.500 |
| Sports Coverage |
100% (URC) 1 for eligible expenses incurred while participating in organized interscholastic or
club sporting activities (non professional) (refer to insurance conditions for exclusions) |
| Accidental Death & Dismemberment |
Up to USD 25,000 / EUR 17.500 |
Current Students 
