Maple Maple Cedar J1 Cedar J1 J1 Premier
Price/30 days
$44.40
$500 ded.
$44.40
$500 ded.
$53.10
$100 ded.
$53.10
$100 ded.
$64.80
$100 ded.
PPO Network UnitedHealthcare Aetna Aetna UnitedHealthcare UnitedHealthcare
Maximum Benefit $100,000 PIS $100,000 PIS $100,000 PIS $100,000 PIS $500,000
Deductible at SHC $500 PIS $500 PIS $100 PIS $100 PIS $100 per illness/injury
Covid-19 Testing ✓ ✓ ✓ ✓ -
Co-Insurance 80% 80% 100% 100% 80%
Physician Visits $0 copay $0 Copay $0 copay $0 copay $0 copay
Urgent Care $0 copay $0 Copay $0 copay $0 copay $0 copay
Emergency Room Visits $250 copay $250 Copay $250 copay $250 copay $250 copay (waived if admitted)
Prescription Drugs 80% 80% 100% 100% $20/$40/$60 copay
Preventive Care Not Covered Not Covered Not Covered Not Covered 100% ($250 Maximum Benefit)
Pre-existing Condition ✓ (after 12 months) Waiting Period 12 Months ✓ (after 12 months) ✓ (after 12 months) 6 months waiting period
Out-of-Pocket Maximum Unlimited Unlimited Unlimited Unlimited $6,950
Maternity Not covered Not Covered Not Covered Not Covered 80%
Mental Health Not covered Not Covered Not Covered Not Covered 80%
Intramural, Club & Recreational Sports Not covered ✘ ✘ - Not Covered
Pediatric Dental/Vision Not covered ✘ ✘ - Not Covered
Medical Evacuation & Repatriation $50,000 ✓ ($50,000 Max) ✓ ($50,000 Max) ✓ ($50,000 Max) $50,000 Combined Maximum Benefit
Return of Mortal Remains $25,000 ✓ ($25,000 Max) ✓ ($25,000 Max) ✓ ($25,000 Max) $25,000
Worldwide Coverage Worldwide Basis, Excluding Home Country ✓ (Except Home Country) ✓ (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.