Coverage Year Limit | $500,000 | $500,000 | $500,000 |
Coverage Limit per Illness/Injury | $300,000 | $300,000 | $300,000 |
Deductible Per Injury or Illness | $100 | $0 or $100 | $0 or $100 |
Coinsurance (In-Network/Out-of-Network) | 100%/80% up to $5,000 | 100%/80% up to $5,000 | 100%/80% up to $5,000 |
Preventative Care (Immunizations & Annual Physical) | Excluded | Up to $100 | Up to $250 |
COVID-19 Coverage | Considered as any other illness | Considered as any other illness | Considered as any other illness |
Outpatient Treatment of Mental and Nervous Disorders | $50 per day; $500 maximum | $50 per day; $1,000 maximum | $50 per day; $1,000 maximum |
Inpatient Treatment of Mental and Nervous Disorders | Up to $10,000 | Up to $10,000 | Up to $10,000 |
| | | |
Pre-Existing Conditions | 12 month waiting period | 12 month waiting period | 12 month waiting period |
Hospital Emergency Room Injury | 100%/80% | 100%/80% | 100%/80% |
Hospital Emergency Room Illness | 100%, subject to $250 deductible if visit does not result in an admission | 100%, subject to $250 deductible if visit does not result in an admission | 100%, subject to $250 deductible if visit does not result in an admission |
Medical treatment arising from participation in Intercollegiate, Intramural, Recreational & Club Sports | $5,000 per injury | $5,000 per injury | $10,000 per injury |
Emergency Medical Evacuation | Up to $500,000 | Up to $500,000 | Up to $500,000 |
Repatriation of Mortal Remains | Up to $50,000 | Up to $50,000 | Up to $50,000 |
Emergency Reunion | Up to $50,000 | Up to $50,000 | Up to $50,000 |
Political Evacuation and Repatriation | Up to $10,000 | Up to $10,000 | Up to $10,000 |
Prescriptions Inpatient | 100% after deductible | 100% after deductible | 100% after deductible |
Prescription Outpatient | 50% | 50% | 50% |
Physical Therapy | 100%, Limit 1 per day | 100%, Limit 1 per day | 100%, Limit 1 per day |
Maternity and Newborn Care | Not covered | Not covered | Not covered |
Accidental Death & Dismemberment | $25,000 | $25,000 | $25,000 |
Repairs to sound, natural teeth required due to an Injury | $500 | $500 | $500 |
Personal Liability (Injury or damage to third person) | Up to $10,000 after $100 deductible | Up to $10,000 after $100 deductible | Up to $10,000 after $100 deductible |
Network | UnitedHealthCare | UnitedHealthCare | UnitedHealthCare |
