ISP Basic (2017-2018)

 

Eligibility:

All international students, scholars or other persons with a current passport who: 1) are engaged in educational activities; and 2) are temporarily located outside his/her home country as a non resident alien; and 3) have not obtained permanent residency status in the U.S. are eligible to enroll in this plan. Those enrolled in an English language or similar program or an Optional Practical Training Program or with an For J visa are also eligible to enroll in the plan. Eligible Dependents of those enrolled in the plan may participate on a voluntary basis. The named insured must actively attend classes for at least the first 31 days after the date for which coverage is purchased with the exception of those with a J visa or those engage in an Optional Practical Training Program.

 

Rate per 30 Days (Deductible $100/$500)

$72.00

Rates per 30 Days (Deductible $500/$750)

$64.80
Benefits Coverage
Maximum Benefit Limit per Sickness or Injury  $500,000
Maximum for Intercollegiate Sports  N/A
Deductible per person (In Network)

Option of $100 per policy year or

$500 per policy year

Coinsurance  80% in Network/60% Out of Network 
Out of Pocket Maximum (In Network)  $10,000
Prescription Drugs $20 for Tier 1
30% Coinsurance Tier 2
40% Coinsurance for Tier 3 
Preventative Care  100% of Preferred Allowance
$1,000 max per year In Network Only
Physician Visits $30 copay
Medical Emergency $100 copay 
Pre-Existing Condition 6 Months 
Evacuation/Repatriation No Maximum 
Nurse Hotline Included  

 ISP Basic Summary Brochure