SUMMARY OF BENEFITS
	For full benefit details, please read the policy brochures.

MEDICAL BENEFITS	PLAN I GLB9124075			PLAN II GLB9124076			PLAN III GLB9124072
Maximum Coverage per Injury or Sickness	$150,000			$250,000			$500,000
Medical Evacuation	$15,000			$50,000			$50,000
Repatriation of Remains	$15,000			$50,000			$50,000
Accidental Death and Dismemberment	$2,500			$15,000			$15,000
% Insurance Pays for First $25,000 in Cost	Claims are paid at 100% of the cost OR the limitations of the policy, whichever is less.						80% of negotiated fee; subject to policy limitation
% Insurance Pays for After $25,000 in Cost	80% of cost up to $150K			80% of cost up to $250K			100% of cost up to $500K
Cost and Services at Student Health Centers	ALL Student Health Center expenses are paid as In Network claims.
Policy on Doctor/Hospital Network (PPO)	If none are availble w/in 35 miles, all benefits are paid as In Network claims.
Pre-Existing Condition	Yes, provided after six (6) months of continuous coverage has been maintained.
Inpatient Mental Health Care, Alcohol & Drug Treatment	80% In Network, 60% Out Network, 30 days max
Outpatient Mental Health Care, Alcohol & Drug Treatment	80% In Network, 60% Out Network, $5,000 max
Prescription Medication	Yes, up to maximum of $1,000.00 per policy year.
Maternity Care	Yes, provided when conception occurs while insured.
Therapeutic Abortion	None						Yes, up to $500 maximum.
Injuries to Sound Teeth	Yes, $100 per tooth to a maximum of $500.
Motor Vehicle Accident	Yes, in excess of the motor vehicle insurance. See policy brochure for details.
Ambulance Service	Yes, for transportation to or from a hospital. See policy brochure for details.
Worldwide Coverage	Yes, worldwide coverage is provided, except for insured's home country.
MONTHLY RATES	PLAN I			PLAN II			PLAN III
Deductible	$0	$250	$500	$0	$250	$500	$0	$250	$500
Age 24 and Under	$46	$43	$39	$55	$52	$50	$85	$81	$79
Age 25 to 29	$49	$46	$42	$58	$55	$52	$95	$85	$81
Age 30 and Above	$91	$84	$79	$108	$100	$95	$166	$150	$142