| Ruby | Gold | Platinum | Blue Diamond | |
|---|---|---|---|---|
| Price/30 days |
$133.80
$90 ded.
|
$105.90
$250 ded.
|
$157.20
$250 ded.
|
$133.20
$250 ded.
|
| PPO Network | UnitedHealthcare | UnitedHealthcare | UnitedHealthcare | UnitedHealthcare |
| Maximum Benefit | Unlimited | $2,000,000 | Unlimited | Unlimited |
| Deductible at SHC | $90/400/1250 per period of insurance | $0 | $0 | $250 per period of insurance |
| Co-Insurance | 80% | 80% | 80% | 80% |
| Physician Visits | $30 copay | $25 copay | $25 copay | $30 copay |
| Urgent Care | $50 copay | $50 copay | $50 copay | $50 copay |
| Emergency Room Visits | $250 copay | $500 copay | $500 copay | $250 copay |
| Prescription Drugs | 80% with $30 copay | 70%; Max. Benefit of $2,000 | $20 copays/$40 copays / 60% co-insurance | 80% with $30 copay |
| Preventive Care | 100% In-Network | 100% In-Network; Max. Benefit of $500 | 100% In-Network | 100% In-Network |
| Pre-existing Condition | No waiting period | $2500 benefit; No exclusion after 6-mos | No Waiting Period | No Waiting Period |
| Out-of-Pocket Maximum | $6,350 | ✘ | $6,350 | $6,350 |
| Maternity | 80% | 80% | 80% | 80% |
| Mental Health | 80% | 80% | 80% | 80% |
| Intramural, Club & Recreational Sports | ✓ | ✘ | ✓ | ✓ |
| Pediatric Dental/Vision | ✘ | ✘ | ✓ | ✘ |
| Medical Evacuation & Repatriation | ✓ ($100,000 Max) | ✓ | ✓ | ✓ ($100,000 Max) |
| Return of Mortal Remains | ✓ ($50,000 Max) | ✓ | ✓ | ✓ ($50,000 Max) |
| Worldwide Coverage | ✓ (except Home Country) | ✓ (except Home Country) | ✓ (except Home Country) | ✓ (except Home Country) |