Liaison Student Medical Insurance

Schedule of Benefits

All amounts listed are in U.S. dollars. Click the titles to see further information.


PLAN INFORMATION & HIGHLIGHTS
Lifetime Maximum More Information
Student $250,000
Dependent $50,000
Deductible – Per Injury or Illness More Information
Non U.S. Students $100 if not first treated by the Student
  Health Center (or if there is no Student Health Center)
  $50 if first treated by the Student Health Center
U.S. Students Options: $0/$50
Co Pay – Per Written Prescription of Medicine More Information
Non U.S. Students $10 for Generic and $20 for Brand Name
U.S. Students $0 for Generic and $0 for Brand Name
Coinsurance More Information
Plan 1: 80% to $10,000, then 100% to plan maximum
Plan 2: 100% to plan maximum
Benefit Period Covered Expenses incurred during the Period of Coverage
Unexpected Recurrence of a Pre-Existing Condition More Information
Non U.S. Students N/A
U.S. Students Up to $500
Maternity Covered as any other illness
Mental Illness More Information
Inpatient: Payable at 50%, up to $10,000 up to a max of 40 days
Outpatient: Payable at 80% , up to $500
Alcohol and Drug Abuse More Information
Inpatient/Outpatient: Payable at 50%, up to $1,000
Injuries from a Motor Vehicle Accident More Information
Non U.S. Students: $10,000
US Citizens: Up to Policy Maximum
Sports-related Injuries More Information
Non U.S. Students: $5,000
US Citizens: Up to Policy Maximum
Dental (emergency $250 per tooth to a maximum of $500
Emergency Medical Evacuation $100,000
Repatriation of Mortal Remains $25,000
Emergency Reunion $5,000
Accidental Death & Dismemberment More Information
$10,000 per Insured
$5,000 per Spouse/Dependent Child
Physiotherapy $500
Spinal Manipulation $500
Ambulance Service $350
Home Country Coverage – Incidental trips to the Insured’s Home Country 30 days of coverage up to a maximum of $1,000 during period of coverage
Home Country Extension of Benefits More Information
  Up to $1,000, expenses must be incurred within 30 days of returning to your Home Country during period of coverage
Assistance 24 hours – Worldwide