Subram
+1-408 469 4415
Patriot Exchange Program 医疗保险
请使用此信息仅作为参考，不要仅根据此信息作出任何决定。如果您有任何疑惑, 问题或疑问。请参阅各保险内容以获取完整的信息。这里无法展示所有详细信息，或致电我们了解更多详情。如果此信息与实际的保险内容有任何差异，则以保险内容为准。
所有的数额都是美元。
保险不承保视力(眼镜等) 。
普通
Patriot Exchange Program℠
Within PPO network: After deductible, plan pays 90% up to $10,000, then 100% up to the policy maximum.
Outside PPO network: After deductible, plan pays 80% up to the policy maximum.
Outside US: After deductible, covers at 100% up to the policy maximum.
$5 copay, deductible waived
医疗 - 门诊
To policy maximum
1 visit per day.
US-Urgent Care: Deductible waived, $50 copay; unless $0 deductible.
US-Walk-in Clinic: Deductible waived, $20 copay; unless $0 deductible.
Co-insurance still applies.
To policy maximum
Extra $500 copay for illness that does not result in hospital admission.
To policy maximum, 90 day supply per prescription. Period of coverage limit: $250,000 per person.
To policy maximum
To policy maximum
To policy maximum
20% of primary surgeon charge. No standby availability coverage.
To policy maximum
To policy maximum
医疗 - 住院
医疗 - 其它治疗和服务
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Standard basic hospital bed and/or standard basic wheelchair
Optional: Adventure Sports, available for ages under 65. Add On, available for High School and College.
To policy maximum, for injury or if covered illness results in hospital admission.
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$10,000. Cannot be provided at a Student Health Center.
$50 per day, $500 maximum. Cannot be provided at a Student Health Center.
Included in the Mental & Nervous Disorder benefit
Chiropractic Care: To policy maximum Physical Therapy: To policy maximum, 1 visit per day Must be ordered in advance by phyisician.
After 12 month waiting period, $500 per period of coverage, $1,500 maximum.
US Citizens: Sudden & Unexpected Reoccurrence: Medical up to $5,000. Medical Evacuation up to $25,000.
-
-
-
50% reduction in benefits, $1,000 maximum penalty
Included
旅程
人寿
$25,000
$25,000
其它
保险特征
Before effective date, full refund.
After effective date, pro-rated refund for whole months minus $50 cancellation fee, as long as no claims have been filed since the effective date; form required.
1 month up to 4 years
$0
Optional: Legal Assistance with Add On, $500 maximum
Optional: Cell phone coverage
Bedside Visit: $1,500
Email
Per Incident
$0 至 64
$100 至 64
$250 至 64
$500 至 64
Per Incident
$50,000 至 64
$100,000 至 64
$250,000 至 64
$500,000 至 64
International Medical Group (IMG)
SiriusPoint Specialty Insurance Corporation
- 医疗给付, 至最高保额,参考正常,合理的惯常费用。免赔额和共同保险适用, 除非注明。
- 当PPO网络内和PPO网络外给付存在差异时,当PPO网络内有益治疗时,以上显示给付适用。
- 除非另有提及，否则保险保障是指每人的保险保障。
- 上方区域的划线（-）表示不适用。
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