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) |