USF World Elite 450 Blue Diamond Ruby
Price/30 days
$82.20
$450 ded.
$141.00
$250 ded.
$141.30
$90 ded.
PPO Network UnitedHealthcare UnitedHealthcare UnitedHealthcare
Maximum Benefit Unlimited Unlimited Unlimited
Deductible at SHC $0 $250 per period of insurance $90/400/1250 per period of insurance
Co-Insurance 100% SHC & 80% In-Network 80% 80%
Physician Visits $20 copay $30 copay $30 copay
Urgent Care $50 copay $50 copay $50 copay
Emergency Room Visits $200 copay (waived if admitted) $250 copay $250 copay
Prescription Drugs $15/$40/$75 copay per prescription 80% with $30 copay 80% with $30 copay
Preventive Care 100% In-Network 100% In-Network 100% In-Network
Pre-existing Condition No Waiting Period No Waiting Period No waiting period
Out-of-Pocket Maximum $5,000 $6,350 $6,350
Maternity 80% 80% 80%
Mental Health 80% 80% 80%
Intramural, Club & Recreational Sports ✓ (Recreational Sports) ✓ ✓
Pediatric Dental/Vision ✘ ✘ ✘
Medical Evacuation & Repatriation ✓ ($120,000) ✓ ($100,000 Max) ✓ ($100,000 Max)
Return of Mortal Remains ✓ ($25,000) ✓ ($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.