| 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) |