INTERNATIONAL
COMMUNITY SERVICE
PLAN A
UNDERWRITTEN
BY MEGA LIFE & HEALTH INSURANCE COMPANY
Maximum
Benefit
$250,000
(For each Injury or Sickness)
Deductible
$50 at Recognized
Student Health Center
In Network
$100 for each Injury or
Sickness Maximum of $300 per person per year
Out of Network
$200 for each Injury
or Sickness -- Maximum of $600.00
per person per year
Preferred Provider
Coinsurance
The Company will pay 100% of Covered
Medical Expenses up to $2,500 then 80% of Covered Medical Expenses up to
$47,500 then 100% of Covered Medical Expenses up to the Aggregate Lifetime
Maximum of $250,000 per Injury/Sickness
Out of Network Provider
Coinsurance
70% of Usual
& Reasonable Covered Expenses
Pre-Existing
Conditions
6 MONTH WAITING PERIOD
Medical
Evacuation / Repatriation
ASSIST AMERICA
Partial
Plan Highlights
|
In Patient |
|
|
Room
Board/Miscellaneous Charges |
$1500 per day |
|
Surgeon |
$5,000.00 |
|
Nervous Mental
include Drug/Alcohol |
30 days same as
any other illness |
|
Out Patient |
|
|
Nervous Mental
include Drug/Alcohol |
30 Visits |
|
Physician Visit |
1 per day |
|
Day Surgery
Charges |
$1,500.00 |
|
Surgeon |
$5,000.00 |
|
OMB – Xray/Lab/Misc
Test/Emergency Room |
$1,000.00 |
|
MRI/CAT Scan |
$1,000.00 |
|
Prescripton
Drugs (w/Disc Card) |
80% to $1000.00 |
|
Abortion |
$300 PPY |
RATES
Annual
Monthly*
Student
$ 876.00 $
73.00
Spouse
$3,516.00
$293.00
Child $1,320.00
$110.00
*minimum of 3 months required
For questions or
more information please contact:
Insurance for Students, Inc
600 Corporate Drive #101
Fort Lauderdale, FL 33334
Phone
800-356-1235
fax
954-772-0872