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Congratulations! You have successfully obtained your initial quote. Please finalize your plan level selection, then complete the application.
Type of Coverage Selected: Student & Family
Participant Age Category: 31-40
Number of Children: 2
Number of Months: 12
Online fulfillment selected
Step 2: Apply for Coverage
Select a Plan Level and Payment Mode:
Area of Coverage Excludes US

 Single payment  Monthly payments
Select   8292.00   691.00    696.00 for each additional payment
Budget   5700.00   475.00    480.00 for each additional payment
Differences Between Select and Budget
  Select Plan Budget Plan
Certificate Period
Maximum
$300,000 (Participant)
$  50,000 (Spouse)
$  50,000 (Child)
$250,000 (Participant)
$  50,000 (Spouse)
$  50,000 (Child)
Maximum Benefit per
Injury or Illness
$300,000 (Participant)
$  50,000 (Spouse)
$  50,000 (Child)
$250,000 (Participant)
$  50,000 (Spouse)
$  50,000 (Child)
Coinsurance
Claims Incurred Inside
US 		Underwriters will pay 80% of the
next $5,000 of Eligible Expenses
after Deductible, then 100% to
Certificate Period Maximum.
For charges incurred within the
PPO or at a Student Health
Center, coinsurance will be
waived 		Underwriters will pay 80% of the
next $10,000 of Eligible Expenses
after Deductible, then 100% to
Certificate Period Maximum
Coinsurance
Claims Incurred Outside
of US 		After the Deductible, Underwriters
will pay 100% of Eligible
Expenses to Certificate Period
Maximum
 Underwriters will pay 80% of the
next $10,000 of Eligible Expenses
after Deductible, then 100% to
Certificate Period Maximum
Routine Nursery Care of
Newborn 		$750 Maximum per Certificate
Period 		$250 Maximum per Certificate
Period
Emergency Medical
Evacuation
$300,000 Lifetime (Participant)
$  50,000 Lifetime (Spouse/Child)
$250,000 Lifetime (Participant)
$  50,000 Lifetime (Spouse/Child)
Emergency Reunion $2,500 Lifetime $1,000 Lifetime
Accidental Death &
Dismemberment
Principal Sum
$25,000 (Participant)
$10,000 (Spouse)
$  5,000 (Child)
No coverage
Repatriation of Remains $25,000 Maximum $15,000 Maximum

 

 

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