INTERNATIONAL
COMMUNITY SERVICE
DISCOUNT
PLAN
UNDERWRITTEN
BY MEGA LIFE & HEALTH INSURANCE COMPANY
Maximum
Benefit
$100,000
(For each Injury or Sickness)
Deductible
-0-
Preferred Provider
Coinsurance
The
Company will pay 80% of Covered Medical Expenses up to $35,000 then 100% of the
Covered Medical Expenses to an Aggregate Lifetime Maximum of $100,000 per
Injury/Sickness
Out of Network Provider
Coinsurance
60% 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 |
$100 Co-pay 1st
3 days |
|
Surgeon |
$7,500 Maximum |
|
Nervous Mental
include Drug/Alcohol |
30 days same as
any other illness |
|
Out Patient |
|
|
Nervous Mental
include Drug/Alcohol |
30 Visits same
as any other illness $20.00 Co-pay |
|
Surgeon |
$7,500 maximum |
|
Day Surgery
Charges |
$100.00 Co-pay $5000 Maximum |
|
Physician¡¯s
Visits |
$20.00 Co-pay |
|
Emergency room |
$75.00 Co-pay
waived if admitted |
|
X-ray / Lab / Misc
Test |
$20 Co-pay per
test |
|
MRI/CAT Scan |
$100 Co-pay -
$1200 maximum benefit |
|
Prescripton
Drugs (w/Disc Card) |
75% to $2,000.00 |
Premium Rates
Student/Scholar
Annual Monthly*
DEPENDENTS Annual Monthly*
Student UNDER 24
$360.00 $
30.00 Spouse UNDER 24 $ 1,392.00
$
116.00
Student 24-30 $420.00
$
35.00 Spouse
24-30 $ 1,632.00 $ 136.00
Student 31-40 $744.00 $
62.00 Spouse
31-40
$ 3,048.00 $ 254.00
Student 41-50 $1,044.00 $
87.00 Spouse
41-50 $ 4,260.00 $ 355.00
Student +51
$2,100.00 $175.00 Spouse +51 $
8,400.00 $ 700.00
*3 month minimum
each Child
$ 852.00 $ 71.00
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