High School Plan
Comprehensive Plan for High School Students
Annual maximum $1,500,000
$0 deductible in-network
$25 co-pay at primary care physician
What the plan covers?
|Annual deductible in-network||$0|
|Annual deductible out-of-network||$125|
|Co-pay urgent care||$50|
|Emergency room co-pay||$150|
|Co-insurance in-network||80% of PPO allowance|
|Co-insurance out-of-network||70% of Reasonable and Customary charges|
|Prescription deductible per fill||$30|
|Wellness & preventative care||Covered at 100% in-network|
|Pre-existing conditions||Covered after 6 months|
|Repatriation of remains||$50,000|
|Provider network||Cigna PPO|
You are eligible if you are a participant of ISO - International Student Organization, are a non-U.S. Citizen, have a current passport or visa and are temporarily residing outside your home country/country of permanent residence, while actively engaged in educational activity and enrolled in classes within 30 days of the plan’s effective date. You are “actively engaged” in educational activity if you are one of the following:
1. F1/M1 valid visa holder. F1 visa holder on OPT is not eligible.
2. Middle School or High School Student registered for and attending classes on a full-time basis.
For purposes of this insurance, if your home country (passport country) is different from your country of permanent residence (location in which you permanently reside), you will not be covered in either location. Permanent residents or persons who have applied for permanent residency are not eligible for coverage under the master policy.