BASE BID: SICKNESS and ACCIDENTAL INSURANCE, meeting Affordable Care Act Specifications MANDATED FOR F-1 INTERNATIONAL STUDENTS WITH HARD WAIVER, AVAILABLE FOR J-1 EXCHANGE VISITOR Injury and Sickness Lifetime Maximum Benefit (Per injury) (Per sickness): Unlimited Annual Maximum Benefit (Per injury) (Per sickness): Unlimited Deductible Preferred Providers: $ 100 (Per injured Person) (Per Policy Year) Deductible Out-of-Network Providers: $ 250 (Per Injured Person) (Per Policy Year) Co-Pays for Student Health Center: $ 0 Co-Insurance Preferred Providers: 90% of Preferred Allowance (PA) except as noted below. Co-Insurance Out-of-Network Providers: 60% of Usual & Customary Charges (U&C) except as noted below. If care is received from a Preferred Provider Covered Medical Expenses will be paid at the Preferred Provider level of benefits. If the Covered Medical Expense is incurred due to a medical emergency, benefits will be paid at the Preferred Provider level of benefits. In all other situations, reduced or lower benefits will be provided when an Out-of-Network Provider is used. The company will pay Covered Medical Expenses incurred at 90% for Preferred Providers and 60% for Out-of-Network. The Insured must pay the $ 100 Preferred Provider Deductible before the benefits start. If Out-of-Network, the insured must pay the $ 250 deductible before benefits start.
