Bronze Silver Gold Diamond Elite Oak J1
Price/30 days
Deductible
PPO Network UnitedHealthcare UnitedHealthcare UnitedHealthcare UnitedHealthcare UnitedHealthcare
Maximum Benefit $500,000 $500,000 $2,000,000 Unlimited $100,000
Deductible at SHC $45 $0 $0 $0 $0
Covid-19 Testing ✓ ✓ ✓ (1 Free without referral) ✓ (1 Free without referral) ✓
Co-Insurance 100% 80% 80% 90% 80%
Physician Visits $0 copay (max $50) $0 copay $25 copay $20 copay $0 copay
Urgent Care $0 copay (max $50) $50 copay $50 copay $50 copay $0 copay
Emergency Room Visits $250 copay $200 copay $150 copay $150 copay $250 copay
Prescription Drugs 100% (max $100) 70% 70% $15/$30/$50 copays 80%
Preventive Care Not Covered Not Covered 100% In-Network 100% In-Network Not Covered
Pre-existing Condition ✓ (after 6 months) ✓ (after 6 months) $2500 benefit; No exclusion after 6-mos No waiting period ✓ (after 6 months)
Out-of-Pocket Maximum ✘ ✘ ✘ $5,000 -
Maternity 100% 80% 80% 90% -
Mental Health 80% 80% 80% 90% -
Intramural, Club & Recreational Sports ✘ ✓ ✘ ✓ -
Pediatric Dental/Vision ✘ ✘ ✘ ✓ -
Medical Evacuation & Repatriation ✓ ($60,000 Max) ✓ ✓ ✓ ✓ ($50,000 Max）
Return of Mortal Remains ✓ ($50,000 Max) ✓ ✓ ✓ ✓ ($25,000 Max)
Worldwide Coverage ✓ ($1,000 for HomeCountry) ✓ (except Home Country) ✓ (except Home Country) ✓ (except Home Country) ✓ (except Home Country)