Pioneer Elite 10K

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 $10,000
    Reduced Copayment for Treatment at Student Health Center
    Emergency Evacuation and Repatriation of Remains Covered at 100% Actual Cost

Rates (Per Month)

$159

Benefits

Coverage

Annual/Lifetime Maximum

Unlimited

Maximum per Covered Accident or Sickness

$500,000

Sports Benefit

$10,000

Treatment Period

First Charges must occur within 30 days after the date of the Covered Accident or Sickness

Deductible

$350 per Policy Period

In Network Coinsurance

Single:  80% of Preferred Allowance up to $25,000; 100% of Preferred Provider Charges thereafter

 
Family:  80% of Preferred Allowance up to $50,000; 100% of Preferred Provider Charges thereafter

Out of Network Coinsurance

60% of Usual and Customary

Maximum Out of Pocket (In Network Only)

$5,000 Single/ $10,000 Family                             

Max out of Pocket Excludes Copays/Deductibles and Non-Covered Charges

Copays:

In-Network

Copay per Visit 

Out of Network

Deductible per Visit 

Dr's Office Visit

$25

(Waived at Student Health Center)

$50

Emergency Room

$150

$250

Hospital room and Board

$150

$250

MRI/CAT Scans

$100

$250

Prescription Drugs

$25 Generic

$50 All Other 

(per prescription)                    

$25 Generic

$50 All Other 

(per prescription)                    

Benefit Period

From the date of the Covered Accident or Sickness to the Policy Termination Date

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 as any other condition.  Conception must occur while covered under the policy

Maximum for Dental Treatment (made necessary by Injury to Sound, Natural teeth only)

$2,500 Injury Only

Max. for Physiotherapy (Outpatient)

30 Visits

Max. for Psychotherapy (Inpatient)

30 Days

Max. for Psychotherapy (Outpatient)

30 Visits

Max. for Braces & Appliances

$5,000

Emergency Evacuation/Repatriation of Remains

100% of Actual Cost

Accidental Death and Dismemberment Principal Sum

$10,000

Emergency Reunion

$2,500

*This Coverage contains a Pre-Existing condition limitation.  Out of Country Medical Maximum benefit of $50,000 may be applicable 

 This is a brief summary of the ISP plan contained within and is not a contract of insurance. The terms and conditions of coverage are set forth in the Plan issued to the Participating Organization. If any conflict should arise between this summary and the respective Plan, the terms of the Plan will govern in all cases.

Pioneer Elite Detail Brochure