Gold Platinum
Price/30 days
$78.90
$500 ded.
$96.30
$250 ded.
$120.60
$500 ded.
$142.80
$250 ded.
PPO Network UnitedHealthcare UnitedHealthcare
Maximum Benefit $2,000,000 Unlimited
Deductible at SHC $0 $0
Co-Insurance 80% 80%
Physician Visits $25 copay $25 copay
Urgent Care $50 copay $50 copay
Emergency Room Visits $500 copay $500 copay
Prescription Drugs 70%; Max. Benefit of $2,000 $20 copays/$40 copays / 60% co-insurance
Preventive Care 100% In-Network; Max. Benefit of $500 100% In-Network
Pre-existing Condition $2500 benefit; No exclusion after 6-mos No Waiting Period
Out-of-Pocket Maximum ✘ $6,350
Maternity 80% 80%
Mental Health 80% 80%
Intramural, Club & Recreational Sports ✘ ✓
Pediatric Dental/Vision ✘ ✓
Medical Evacuation & Repatriation ✓ ✓
Return of Mortal Remains ✓ ✓
Worldwide Coverage ✓ (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.