Benefits
Eligibility: You may be covered under this Plan if you are enrolled as a full-time student in SABA University, School of Medicine and you are temporarily pursing educational activities outside of the United States. International students are not eligible for coverage in their Home Country. You may also enroll your lawful spouse and unmarried children under age 19 who are traveling and residing with you, provided they are dependent upon you for maintenance and support. Any children born to you and your spouse while you are covered under the plan will be insured from the moment of birth. Coverage on a newborn child will cease 31 days after the date of birth unless the Company receives notification of the birth, a completed enrollment form and required premium.
Period of Coverage: Coverage will begin at 12:01 a.m. Local Time on the latest of the following: a) a covered person’s departure from the United States; b) the date the enrollment form and premium are received by the Company or its designated administrator; or c) the date requested in the enrollment form. Coverage will end on the earliest of the following: a) the date of a covered person’s return to their Home Country or the United States, except as provided under the Home Country Benefit; b) the date through which premium has been paid; or c) the coverage termination date under the Policy provisions.
Definitions: Sickness means an illness, disease or condition of the covered person that causes a loss for which a covered person incurs medical expenses while covered under the Policy. All related conditions and recurrent symptoms of the same or similar condition will be considered one Sickness. Pregnancy is included in the definition of Sickness. Injury means accidental bodily harm sustained by a covered person that results directly and independently from all other causes from a covered accident. The Injury must be caused solely through external and accidental means. All injuries sustained by one person in any one Accident, including all related conditions and recurrent symptoms of these injuries are considered a single Injury. Medically Necessary means a treatment, service or supply that is: 1) required to treat an Injury or Sickness; 2) prescribed or ordered by a doctor or furnished by a hospital; 3) performed in the least costly setting required by the covered person’s condition; and 4) consistent with the medical and surgical practices prevailing in the area for treatment of the condition at the time rendered. A service or supply may not be Medically Necessary if a less intensive or more appropriate diagnostic or treatment alternative could have been used. The Company may, at its discretion, consider the cost of the alternative to be the covered expense. Home Country means a country from which the covered person holds a passport. If the covered person holds passports from more than one country, his or her Home Country will be that country which the covered person has declared to the Company, in writing, as his or her Home Country.
Medical Expense Benefits: If an Injury or Sickness occurs during the Period of Coverage and the covered person requires medical or surgical treatment, the Company will pay, after a $50.00 deductible per covered Injury or Sickness, 100% up to $5,000 of the first $5,000, then 80% to the maximum of $500,000 for usual and customary charges listed under covered expenses. The covered expenses shall in no event include any amount which is in excess of the usual and customary charges. In no event shall the Company’s liability for a covered person exceed $500,000.
Covered Expenses: To be considered a Covered Expense under this Plan, it must: a) have been incurred as the result of, and within 52 weeks of, a covered Sickness or Injury outside of the Home Country during the Period of Coverage; b) not be excluded by provisions of this Plan; and c) be specifically included in the following list of expenses:
1. Expenses made by a hospital for room and board, including registered nursing services and any other medically necessary hospital services, but not including personal services of a non-medical nature. However, allowable expenses may not exceed the hospital’s average charge for semiprivate room and board accommodation.
2. Expenses made for diagnosis, treatment and surgery by a doctor.
3. Expenses made for the cost and administration of anesthetics.
4. Expenses for physiotherapy, if recommended by a doctor for the treatment of a specific disablement administered by a licensed physiotherapist. Chiropractic care: limited to 80% of covered expenses, up to $35 per visit, with a maximum of 10 visits per Injury or Sickness.
5. Expenses for physiotherapy, if recommended by a doctor for the treatment of a specific disablement administered by a licensed physiotherapist.
6. Expenses for prescription drugs including dressings, drugs and medicines prescribed by a doctor. The Company will pay 100% of inpatient expenses incurred, and 50% of outpatient expenses incurred.
7. Expenses for dental expenses resulting from an Injury to sound, natural teeth, up to $100 per tooth, $500 maximum benefit.
8. Expenses for therapeutic termination of pregnancy, up to a $500 maximum benefit.
9. Expenses for newborn nursery care, up to a $500 maximum benefit.
10. Expenses incurred for treatment of nervous or mental disorders. Benefits are payable a) for inpatient treatment, 50% of covered expenses for inpatient treatment up to a maximum of 30 days; b) up to a $300 maximum for outpatient treatment.
Home Country Benefits: The Home Country benefit provides coverage if the covered person obtains treatment: 1) for an Injury or Sickness within 60 days of returning from a trip to his or her Home Country, or 2) for a continuation of benefits for treatment that began during the course of a trip for which a benefit is otherwise payable under the Medical Expense Benefit. The Company will pay, after an additional $100 deductible, 100% of covered expenses, up to $5,000, then 80% to the maximum of $25,000. The covered person must remain continuously insured, including while on vacations and school breaks. The Company will pay benefits, subject to the limitations set out herein, for Covered Accident and Sickness Medical Services received by the covered person, while he or she is in his or her Home Country, for such Injury or Sickness.
Accidental Death and Dismemberment: If a covered person’s Injury results in any of the following losses within 365 days after the date of accident, the Company will pay the sum shown opposite the loss. The Company will not pay more than the Principal Sum for all losses due to the same accident.
Principal Sum: $15,000
Description of Loss Indemnity
Life, Both Hands or Both Feet or Sight of Both Eyes, One Hand and
One Foot, Either Hand or Foot and Sight of One Eye Principal Sum
Either Hand or Foot or Sight of One Eye One-Half the Principal Sum
The term “loss” as used herein shall mean, with regard to hands and feet, actual severance through or above wrist or ankle joint, and with regard to eyes, entire irrecoverable loss of sight. “Severance” means the complete separation and dismemberment of the part of the body.
Coordination of Benefits: If a covered person is covered by more than one insurance program, benefits will be subject to a Coordination of Benefits Provision. A plan, which does not have such a provision, would pay benefits first. In all other instances, the plan that will pay benefits first is: a) the plan which covers the covered person as an employee rather than as a full or part-time student; b) if a) does not apply, the plan which covers the covered person as a full or part-time student rather than as a dependent; c) if a) and b) do not apply, the plan which covers the person as a dependent, subject to specific rules contained in the policy; d) if a), b) and c) do not apply, the plan which has covered the covered person for the longer time. If the benefits of this Plan are reduced to these rules, such reduction will be done in proportion. Any benefits paid by this plan on a reduced basis will be charged against the benefit limits of this Plan.
