SU-SP

Study USA Basic Plan

Limited Coverage,  Rated A (Excellent)By: TIS,  UW: Lloyd'sLloyd's of London
AM Best Rating
A (Excellent)
Carrier/Underwriter
Lloyd's of London
Administrator
TIS
COVID-19 Excluded
extendable-cancelable
Extendable & Cancelable
urgent-care
Urgent Care
Coverage from 5 days to 12 months
BUY

Study USA insurance is for students studying outside of their home country and their eligible dependents who want medical coverage.

Please review Study USA Basic Insurance Brochure brochure or policy document for complete and accurate coverage information.

Out-Patient

Dr. / Physician Visit

Within the PPO network: After the deductible is satisfied, the insurance company will pay 80% of eligible medical expenses up to the policy maximum.
Outside the PPO network: After the deductible is satisfied, the insurance company will pay the URC for eligible medical expenses up to the policy maximum.

Urgent Care

Within the PPO network: After the deductible is satisfied, the insurance company will pay 80% of eligible medical expenses up to the policy maximum.
Outside the PPO network: After the deductible is satisfied, the insurance company will pay the URC for eligible medical expenses up to the policy maximum.

Surgical Treatment

Within the PPO network: After the deductible is satisfied, the insurance company will pay 80% of eligible medical expenses up to the policy maximum.
Outside the PPO network: After the deductible is satisfied, the insurance company will pay the URC for eligible medical expenses up to the policy maximum.

Prescription Drugs / Medicines

Covered only for out-patient prescription
50% of actual prescription cost covered.

Lab & X-rays

Within the PPO network: After the deductible is satisfied, the insurance company will pay 80% of eligible medical expenses up to the policy maximum.
Outside the PPO network: After the deductible is satisfied, the insurance company will pay the URC for eligible medical expenses up to the policy maximum.

Physical Therapy

Up to $25 per visit per day. Must be ordered in advance by a physician and not obtained at a student health center.

In-Patient

Hospital Room

Plan will pay average semi-private room rate, including nursing services.

Surgical Treatment

Within the PPO network: After the deductible is satisfied, the insurance company will pay 80% of eligible medical expenses up to the policy maximum.
Outside the PPO network: After the deductible is satisfied, the insurance company will pay the URC for eligible medical expenses up to the policy maximum.

Hospital Intensive Care Unit

Up to the overall maximum limit

Drug/Alcohol Abuse

Treatment must not be provided at a student health center.
Outpatient: $50 maximum per day
$500 maximum. Inpatient: Up to $5,000.

Emergency Services

Ambulance Expenses

$300 /injury or illness when covered injury or illness results in inpatient hospitalization

Emergency Room(ER)

For claims incurred in the US, plan pays up to $500 for treatment received in an emergency room, unless admitted as inpatient.

Dental

Acute, spontaneous and unexpected pain

Not Covered

Accidental emergency

Not Covered

Travel

Emergency Medical Evacuation / Repatriation

Up to $50,000 lifetime maximum

Return of Remains

Up to $25,000 lifetime maximum

Emergency Reunion

Up to $1,500 subject to a maximum of 15 days

Life

Other

Mental Illness

Outpatient: $50 maximum per day, $500 maximum.
Inpatient: Up to $5,000.
Treatment must not be provided at a student health center.

Maternity

Not Covered

General Physical full Checkup

Not Covered

Terrorism Coverage

$50,000 maximum Lifetime Limit (eligible medical expenses only)

Brochure

Support

24-Hrs Emergency Assistance

Yes Contact number and details can be found on the ID card.

Plan Administrator Company

TIS

Carrier / Underwriter

Lloyd's of London

AM Best Rating

A (Excellent)

Eligibility

Primary applicants must be under age 65; and a full time student at a college or university (excluding online colleges and universities), or within 31 days of being a full-time student at a college or university (excluding online colleges and universities), or a student under age 19 enrolled in a secondary school, or a full-time scholar affiliated with an educational institution and performing work or research for at least 30 hours per week, and you must be residing outside your home country for the purpose of pursuing international educational acitivities, and you must not have obtained residency status in your host country, and if in the U.S., you must hold a valid education-related visa. A copy of the I-20 or DS2019 may be requested. J-1 and F-1 visa holders: The full-time student/scholar status requirement is waived within the U.S. if you have a valid F-1 visa (including OPT) or a J-1 visa. Full-time status requirements remain in force for individuals for individuals holding M-1, or other category visas.

Deductible Content

Deductible Per Incident
What is Deductible?

Deductible is the amount that you are responsible for, before insurance company starts paying for any covered expenses. Deductible for this type of plan is applicable once per incident.


For example: If you visit a doctor for a medical problem, and after consultation, the doctor prescribes Medicines, X-rays, and Lab tests, then since all these services are part of one incident, your deductible will be applicable for these services only once. If you visit a doctor again after a few days for a new problem, the deductible will be applicable again for that new incident.
What deductible to choose with this Plan?

Since deductible is per incident for these type of plans. It is a good idea to select a lower deductible such as “0“.

Note : For Age 70 and above, lower deductible like Zero “0“ is not available.

Plan Type

Comprehensive Coverage Plan

Coverage in U.S.A.

Covered

Coverage outside U.S.A.

Covered

Co-Pay

Co-pays for prescription drugs and ER visits.

Trip Interruption

Not Covered

Co-Insurance

Within the PPO network: After the deductible is satisfied, the insurance company will pay 80% of eligible medical expenses up to the policy maximum.
Outside the PPO network: After the deductible is satisfied, the insurance company will pay the URC for eligible medical expenses up to the policy maximum.

How the Benefits are Paid

Within the PPO network: After the deductible is satisfied, the insurance company will pay 80% of eligible medical expenses up to the policy maximum.
Outside the PPO network: After the deductible is satisfied, the insurance company will pay the URC for eligible medical expenses up to the policy maximum.

Plan Effective Date

Effective Date of Insurance:

1. 1. The moment underwiters receive the application and correct premium(if payment and application is made online or by fax)or
2. 12.01 am US Eastern Time on the date undewriters receive the application and payment (if payment and application is made by mail)or
3. 12.01 am US Eastern Time on the date the participants meet the eligibility requirement

Plan End Date

Termination of Insurance: Your insurance will terminate at the earliest of:

1. 11.59 pm US Eastern Time on the last date of the period for which premium has been paid
2. 11.59 pm US Eastern Time on the last date requested on the application
3. 12.01 am US Eastern Time on the date the participant no longer meets the eligibility requirement
4. The moment the participant returns to the home country(except as allowed by home country coverage provisions of this coverage)

Deductible Type

Per Incident

Renewability

Extendable up to 4 years

Cancellation

Full refund available if canceled before start date. Monthly (if paying monthly in installments) or daily (if paid in full) pro-rated refund if canceled after start date and no claims have been filed ($25 cancellation fee applies). No refund available after 60 days of coverage. For monthly payments, after effective date, all subsequent payments would be stopped after receiving the cancellation request.

PPO Network

PPO Network

Available Deductibles

$250 per injury/illness within the PPO network or student health center, otherwise $500 per injury/illness. If treatment received outside U.S., $250 per illness/injury.

Available Coverage

Overall Maximum Limit - $200,000, Maximum per injury/illness - $100,000

Provider Directory

By Provider, Phone Nos.: 800-937-1387 or number on ID card

Plan Brochure

Study USA Basic Insurance Brochure brochure

Disclaimer

Plan features listed here are high level, provided for your convenience and information purpose only. Please review the Evidence of Coverage and Plan Contract (Policy) for a detailed description of Coverage Benefits, Limitations and Exclusions. Must read the Policy Brochure and Plan Details for complete and accurate details. Only the Terms and Conditions of Coverage Benefits listed in the policy are binding.