Coverage Year Limit |
$500,000 |
$500,000 |
$500,000 |
Coverage Limit per Illness/Injury |
$300,000 |
$300,000 |
$300,000 |
Deductible Per Injury or Illness |
$100 |
$0 or $100 |
$0 or $100 |
Coinsurance (In-Network/Out-of-Network) |
100%/80% up to $5,000 |
100%/80% up to $5,000 |
100%/80% up to $5,000 |
Preventative Care (Immunizations & Annual Physical) |
Excluded |
Up to $100 |
Up to $250 |
COVID-19 Coverage |
Considered as any other illness |
Considered as any other illness |
Considered as any other illness |
Outpatient Treatment of Mental and Nervous Disorders |
$50 per day; $500 maximum |
$50 per day; $1,000 maximum |
$50 per day; $1,000 maximum |
Inpatient Treatment of Mental and Nervous Disorders |
Up to $10,000 |
Up to $10,000 |
Up to $10,000 |
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Pre-Existing Conditions |
12 month waiting period |
12 month waiting period |
12 month waiting period |
Hospital Emergency Room Injury |
100%/80% |
100%/80% |
100%/80% |
Hospital Emergency Room Illness |
100%, subject to $250 deductible if visit does not result in an admission |
100%, subject to $250 deductible if visit does not result in an admission |
100%, subject to $250 deductible if visit does not result in an admission |
Medical treatment arising from participation in Intercollegiate,
Intramural, Recreational & Club Sports |
$5,000 per injury |
$5,000 per injury |
$10,000 per injury |
Emergency Medical Evacuation |
Up to $500,000 |
Up to $500,000 |
Up to $500,000 |
Repatriation of Mortal Remains |
Up to $50,000 |
Up to $50,000 |
Up to $50,000 |
Emergency Reunion |
Up to $50,000 |
Up to $50,000 |
Up to $50,000 |
Political Evacuation and Repatriation |
Up to $10,000 |
Up to $10,000 |
Up to $10,000 |
Prescriptions Inpatient |
100% after deductible |
100% after deductible |
100% after deductible |
Prescription Outpatient |
50% |
50% |
50% |
Physical Therapy |
100%, Limit 1 per day |
100%, Limit 1 per day |
100%, Limit 1 per day |
Maternity and Newborn Care |
Not covered |
Not covered |
Not covered |
Accidental Death & Dismemberment |
$25,000 |
$25,000 |
$25,000 |
Repairs to sound, natural teeth required due to an Injury |
$500 |
$500 |
$500 |
Personal Liability (Injury or damage to third person) |
Up to $10,000 after $100 deductible |
Up to $10,000 after $100 deductible |
Up to $10,000 after $100 deductible |
Network |
UnitedHealthCare |
UnitedHealthCare |
UnitedHealthCare |
