Pioneer Elite 15K

The Pioneer Elite plan is designed with intercollegiate athletes in mind, as it provides benefits for accidents and sicknesses that occur while participating in
intercollegiate sports.  There are 3 Sports benefit options: $10,000, $15,000 and $20,000.

The Pioneer Elite plan is ISP’s high-end program, which meets J-1 state department visa requirements and most university waiver requirements.

The Pioneer Elite is not available in all states or to all schools. Plan design may vary on a state by state basis.

  • Sports Limit of $15,000
    Reduced Copayment for Treatment at Student Health Center
    Emergency Evacuation and Repatriation of Remains Covered at 100% Actual Cost

Rates (Per Month)

$168
 

In                                                            Network

Out of Network
Annual/Lifetime Maximum Unlimited
Sport Benefit $15,000
Medical Maximum per Covered Accident or Sickness $500,000
First Treatment First Charge must occur within 30 days after the date of the Covered Accident or Sickness
Deductible   $200 per Policy Period 
Coinsurance Single:  80% of PPO Allowance for the first $25,000; 100% of Covered Expenses thereafter                                                        75% of Usual and Customary
  Family:  80% of PPO Allowance for the first $50,000; 100% of Covered Expenses thereafter                                                        75% of Usual and Customary
Maximum Out of Pocket $5,000 Single/ $10,000 Family N/A
  Max out of Pocket Excludes Copays/Deductibles/ Non Covered Charges  
Copays:    
Dr's Office Visit  $25 (Waived at SHC) $40
Emergency Room $150 $250
Hospital Room and Board** $150 $250
MRI/ CAT Scan** $100 $250
Prescription Drugs $25 Generic $50 All Other
Benefit Period Benefits Terminate when your policy ends
Extension of Benefits 3 Months if Hospitalized for a Covered Accident or Sickness at time of Coverage Expiration Date
Pre-Existing Condition Limitation 6 months (Prior Creditable coverage under an ISP Policy)*
Pregnancy Covered if Conception Occurs after coverage is in force
Maximum for Dental Treatment $2,500 (Injury Only)
Max. for Chiropractic Care $5,000
Max. for Physiotherapy (Outpatient) 30 Visits
Max. for Psychotherapy (Inpatient) 30 Days
Max. for Psychotherapy (Outpatient) 30 Visits
Max. for Braces & Appliances $5,000
Max. for Routine Newborn Hospital Nursery Care $3,000 $1,500
Emergency Evacuation 100% of Actual Cost
Repatriation of Remains 100% of Actual Cost
Accidental Death & Dismemberment $10,000
Emergency Reunion $2,500
Family Reunion $2,500
* This coverage contains a Pre-existing condition limitation.  Maximum benefit of $50,000 may be applicable.  The Pre-existing Conditions definitions are defined within the policy forms and may vary based on the state of issuance.
**Prior Notification Required  

View Pioneer Elite Policy Brochure