Maximum Benefit Limit per Sickness or Injury

$100,000

$200,000

$100,000

$250,000

Maximum Benefit per Lifetime

$100,000

$200,000

$250,000

500,000

Maximum per Sports-Related Injury

Not covered

$5,000

Deductible Person per Sickness or Injury

$50/$45 if first rendered at SHC

$0

$0

Pre-Existing Condition

3 months (credit is applied for prior continuous coverage)

3 months (credit is applied for prior continuous coverage)

Covered with no waiting period

Security Evacuation

$100,000

N/A

Hospital Room and Board

$1,000/day 30 day maximum

$1000/day 30 day maximum

Hospital Miscellaneous

$500/day

$500/day

Hospital Intensive Care Unit

Additional $525/day; 8 day maximum

Additional $600/day for 8 day maximum

Surgical Treatment

$25,000 maximum

$50,000 maximum

$25,000

$50,000

Anesthetist

25% of surgical benefit

25% of surgical benefit

Assistant Surgeon

25% of surgical benefit

25% of surgical benefit

Physician Non-Surgical 

$60/visit; 1 visit/day/30 visit maximum

$60/visit 30 day maximum

Consulant Physician, when Requested by Attending Physician

$400 maximum

$400

Pre-Admission Tests within 7 Days before Hospital Admission

$900 maximum

$900

Private Duty Nurse

$500 maximum

N/A

Diagnostic X-Rays and Lab Service (Oupatient)

$1000 maximum

$400

CAT Scan, PET Scan or MRI

Additional $250 one CAT scan,
PET scan or MRI

$250

Prescription Drugs

$500 maximum

$500

$1000

Prescription Copay

$25
*Not subject to deductible

N/A

Day Surgery Miscellaneous

$2,500

$3,500

$7,500

$10,000

Ambulance Services

$400 maximum

$400

Initial Orthopedic Prosthesis or Brace

$1,000 maximum

$1,000

Emergency Replacement of Eye Glasses, Contact Lenses and Hearing Aids

Not covered

$300

Dental Treatment for Injury to Sound Natural Teeth

$500 maximum

$500

$1,000

Rehabilitative Brace or Appliances

$1,000 maximum

$1,000

Chemotherapy and/or Radiation Therapy

$1,000 maximum

$1,000

Physiotherapy

$35/visit, 1 visit/day; 12 visit maximum

$50/visit 12 visit maximum

$75/visit 12 visit maximum

Mental & Nervous Disorder and Substance Abuse

Same as any other sickness

Paid as any other sickness.
40 visit maximum

Maternity (conception must occur while coverage is in force)

$7,500 natural;
$10,000 C Section

$7,500 for natural additional
$2,500 for C Section

Newborn Nursery Care

Not Covered

$500

Therapeutic Termination of Pregnancy

Not Covered

$500

Home Country Coverage

$500

N/A

Emergency Medical Reunion

$1,000 Lifetime

$1,500 Lifetime

$2,500 maximum

Emergency Evacuation

$100,000

$200,000

100% of covered expenses

Repatriation of Remains

$50,000

$100,000

100% of covered expenses

Accidental Death and Dismemberment Coverage

$15,000

$25,000

Aggregate per Accident

$250,000

$250,000

Parlaysis

Included

Included

Coma

Included

Included

Assistance Company

Travel Guard

Europe Assist

Lost Baggage

Not Covered

$250/bag max 2 bags

Age 29 and under

$26

$37

Age 25 and Under

$24

$31

30 – 39

$101

$97

26 – 29

$45

$50

40 – 50

$101

$126

30 – 65

$105

$126

51 – 65

$129

$132

Dependents

$135

$165

Dependent

$173

$198