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.
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.
Rates (Per Month)
|
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 Per Insured Member |
$350 per Coverage Year |
|
|
In Network Coinsurance Per Insured Member |
80% of PPO Allowance up to $25,000; 100% Covered Expenses thereafter |
|
|
Out of Network Coinsurance Per Insured Member |
60% of Usual and Customary |
|
|
Maximum Out of Pocket Per Insured Member |
$5,000 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 (Waived at Student Health Center) |
|
Urgent Care |
$25 |
$50 |
|
Hospital and Physician Outpatient Services |
$50 |
$250 |
|
Inpatient Hospital Services |
$150 |
$250 |
|
Emergency Room |
$150 |
$250 |
|
Prescription Drugs |
$25 Generic $50 All Other (per prescription) |
$25 Generic $50 All Other (per prescription) |
|
Benefit Period |
Policy Termination |
|
|
Extension of Benefits |
3 Months if Hospitalized for a Covered Accident or Sickness at time of Coverage Expiration Date. |
|
|
Pregnancy |
Covered as any other condition. |
|
|
Maximum for Dental Treatment (made necessary by Injury to Sound, Natural teeth only) |
$2,500 Injury Only |
|
|
Maximum for Chiropractic Care |
$5,000 |
|
|
Max. for Physiotherapy (Outpatient) |
30 Visits |
|
|
Max. for Psychotherapy (Inpatient) |
30 Days |
|
|
Max. for Psychotherapy (Outpatient) |
30 Visits |
|
|
Emergency Evacuation/Repatriation of Remains |
100% of Actual Cost |
|
|
Accidental Death and Dismemberment Principal Sum |
$10,000 |
|
|
Emergency Reunion |
$2,500 |
|
|
Family Reunion |
$2,500 |
|
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.
