Sapphire Gold Blue Diamond
Price/30 days
$81.00
$90 ded.
$105.90
$250 ded.
$133.20
$250 ded.
PPO Network UnitedHealthcare UnitedHealthcare UnitedHealthcare
Maximum Benefit $500,000 PIS $2,000,000 Unlimited
Deductible at SHC $45 $0 $250 per period of insurance
Co-Insurance 80% 80% 80%
Physician Visits $0 copay $25 copay $30 copay
Urgent Care $0 copay $50 copay $50 copay
Emergency Room Visits $300 copay $500 copay $250 copay
Prescription Drugs 80% 70%; Max. Benefit of $2,000 80% with $30 copay
Preventive Care Not Covered 100% In-Network; Max. Benefit of $500 100% In-Network
Pre-existing Condition No Waiting Period $2500 benefit; No exclusion after 6-mos No Waiting Period
Out-of-Pocket Maximum $2,000 ✘ $6,350
Maternity 80% 80% 80%
Mental Health 80% 80% 80%
Intramural, Club & Recreational Sports ✘ ✘ ✓
Pediatric Dental/Vision ✘ ✘ ✘
Medical Evacuation & Repatriation ✓ ($60,000 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)
The plan comparison and benefit information provided on this webpage is for general reference only and does NOT guarantee coverage or payment. For complete and detailed information regarding your coverage, plan benefits, exclusions, and claims procedures please download the official Policy Brochure and/or Terms & Conditions. The provisions outlined in the Policy Brochure and/or Terms & Conditions will prevail.