SUSA-P

Study USA Platinum

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 Included
extendable-cancelable
Extendable & Cancelable
urgent-care
Urgent Care
Coverage from 5 days to 12 months
  • Optional Intercollegiate, Interscholastic, Intramural, or Club Sports Rider
  • Optional Vaccination Benefit Rider
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 Platinum Insurance Brochure or policy document for complete and accurate coverage information.

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 up to the policy maximum for eligible medical expenses.
Urgent Care
Within the PPO network:After the deductible is satisfied, the insurance company will pay 85% of eligible medical expenses up to $10,000 then 100% thereafter.
Outside the PPO network:After the deductible is satisfied, the insurance company will pay the URC up to the policy maximum for eligible medical expenses.
Surgical Treatment
Within the PPO network:After the deductible is satisfied, the insurance company will pay 85% of eligible medical expenses up to $10,000 then 100% thereafter.
Outside the PPO network:After the deductible is satisfied, the insurance company will pay the URC up to the policy maximum for eligible medical expenses.
Prescription Drugs / Medicines
Covered as per the policy
(Co-payments: $15 for generic and $30 for brand names)
Lab & X-rays
Within the PPO network:After the deductible is satisfied, the insurance company will pay 85% of eligible medical expenses up to $10,000 then 100% thereafter.
Outside the PPO network:After the deductible is satisfied, the insurance company will pay the URC up to the policy maximum for eligible medical expenses.
Physical Therapy
Maximum $75/visit/day. Coinsurance waived for physical therapy and chiropractic treatment.
Hospital Room
Average semi-private room rate, including nursing services
Surgical Treatment
Within the PPO network:After the deductible is satisfied, the insurance company will pay 85% of eligible medical expenses up to $10,000 then 100% thereafter.
Outside the PPO network:After the deductible is satisfied, the insurance company will pay the URC up to the policy maximum for eligible medical expenses.
Hospital Intensive Care Unit
Up to the overall maximum limit
Drug/Alcohol Abuse
Within the PPO network:After the deductible is satisfied, the insurance company will pay 85% of eligible medical expenses up to $10,000 then 100% thereafter.
Outside the PPO network:After the deductible is satisfied, the insurance company will pay the URC up to the policy maximum for eligible medical expenses.
Maximum 30 visits for inpatient and outpatient
Treatment must not be provided at a student health center
Ambulance Expenses
Up to $350 per injury or illness, when covered illness or injury results in hospitalization as inpatient.
Coinsurance waived for the local ambulance.
Emergency Room(ER)
Up to $100 for treatment received in the ER, unless admitted as an inpatient
Acute, spontaneous and unexpected pain
$100 maximum
Accidental emergency
$1,000 maximum. Coinsurance waived for dental treatment due to accident.
Emergency Medical Evacuation / Repatriation
$500,000 lifetime maximum
Return of Remains
$ 50,000-lifetime maximum
Emergency Reunion
Up to $5,000-subject to a maximum of 15 days
Return of minor Child(ren)
Not Covered
Trip Interruption
Not Covered
Loss of checked Baggage
Not Covered
AD&D
$25,000 Lifetime Maximum
DeathPrincipal Sum
Loss of 2 LimbsPrincipal Sum
Loss of 1 LimbOne Half of Principal Sum
Common Carrier Accidental Death
Not Covered
Pre-Existing Conditions
Coverage after a 6 month waiting period
Maternity
If conception happens after the policy effective date, after the deductible, the insurance company will pay 80% up to the $25,000, in-network.
Out of network, the insurance company will pay the URC up to $25,000
Nursery care for newborns
Therapeutic termination of pregnancy
General Physical full Checkup
100% coverage of one routine physical exam per member
Terrorism Coverage
$50,000 lifetime maximum, eligible medical expenses only
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 85% of eligible medical expenses up to $10,000 then 100% thereafter.
Outside the PPO network:After the deductible is satisfied, the insurance company will pay the URC up to the policy maximum for eligible medical expenses.

How the Benefits are Paid

Within the PPO network:After the deductible is satisfied, the insurance company will pay 85% of eligible medical expenses up to $10,000 then 100% thereafter.
Outside the PPO network:After the deductible is satisfied, the insurance company will pay the URC up to the policy maximum for eligible medical expenses.

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)

Coverage Type

Comprehensive Coverage Plan

Deductible Type

Per Incident, Per Injury, or Sickness

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)

PPO Network

PPO Network

Coverage Length

30 days to 364 days. (Can be renewed up to 4 years)

Available Deductibles

$25 per injury/illness within the PPO network or student health center, otherwise $100 per injury/illness. If treatment received outside U.S., $25 per illness/injury.

Available Coverage

Overall Maximum Limit - $3,00,000, Maximum per injury/illness - $500,000

Provider Directory

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

Plan Brochure

Study USA Platinum 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.