Liaison Student Basic provides medical insurance benefits to students and other educational professionals with valid J-1, H-3, F, M or Q Visas. It can be renewed as long as the student satisfy the eligibility requirements and also offers coverage for maternity.
Non US Citizens and U.S Citizens
International Students, visiting faculty, scholars between 12 and 64 years of age and the student must be engaged in full-time educational, research activities residing outside their home country.
Non US citizens must have a valid J-1, H-3, F-1, M-1 or Q-1 Visa and are covered if destination is the United States.
U.S. citizen must have a current passport and visa issued by their host country and are covered for destinations outside of the United States.
COVERAGE : 5 days to 364 days
COUNTRY RESTRICTIONS :
State Restrictions: The plan will not accept a mailing address in Maryland, Washington, New York, South Dakota, and Colorado.
Country Restrictions: The plan will not accept an address in Islamic Republic of Iran, Syrian Arab Republic, U.S. Virgin Islands, Gambia, Ghana, Nigeria, and Sierra Leone.
Destination Restrictions: The plan will not cover trips to Islamic Republic of Iran and Syrian Arab Republic.
RATING : A (excellent) by AM Best UNDERWRITERS : Certain Underwriters at Lloyd's of London (rated "A" (Excellent) by AM Best) and Tramont Insurance Company Limited. ADMINISTRATOR : Seven Corners
Refund of full premium if the policy is cancelled before the effective date. If the cancellation request is received after the policy start date, you will get pro-rata refund after deducting the cancellation charges.
Plan does not pay 100% of medical maximum. Co-insurance applies.
Co-pay for prescription drugs inside the US.
Pre-existing diseases covered only after 364 days waiting period.
Lesser benefits when compared to more expensive plans.
Policy MaximumAges 14 days to 59 years: $50,000; $100,000; $250,000; $500,000 Ages 60 to 64 years: $50,000; $100,000; $250,000
Ages 14 days to 59 years: $50; $100; $250 Ages 60 to 64 years: $100; $250
Inside the United States
In ppo network : We pay 80% of the first $5,000, then 100% to the medical maximum..
Out of ppo network : We pay 70% of the first $5,000, then 100% to the medical maximum.
Inside the United States
The plan pays 100% to the medical maximum.
Medical Maximum Options Ages 14 days to 59 years: $50,000; $100,000; $250,000; $500,000 Ages 60 to 64 years: $50,000; $100,000; $250,000
Deductible Options Ages 14 days to 59 years: $50; $100; $250 Ages 60 to 64 years: $100; $250
Hospital Room & BoardURC to medical maximum
Emergency Room Services$100 copay
Doctor’s Office Visits$15 copay
Urgent Care Visits$30 copay
Prescription Drugs$15 copay
Physiotherapy$25 per visit, 60 visits maximum
Spinal Manipulation$25 per visit, 60 visits maximum
Local Ambulance Benefit$350
Coma benefit$10,000 separate from the medical maximum
Felonious assault$10,000 separate from the medical maximum
Extension of Benefits to Home Country$1,000
Incidental Trips to Home Country $1,000
Acute Onset of Pre-existing Conditions$5,000
Mental Illness including Alcohol and Substance AbuseInpatient: $5,000, 45-day limit Outpatient:80% up to $500
Motor Vehicle AccidentInside the United States: 50% up to $100,000 Outside the United States: Up to medical maximum
Non-contact Amateur Sports$2,500
Maternity CareInside the United States : Not Available Outside the United States :Not Available
Routine Newborn CareNot Available
Dental — Sudden Relief of Pain$150
Dental Emergency — Accident$500
Emergency Medical Evacuation & Repatriation$100,000
Emergency Medical Reunion$200 per day, 10-day limit
Return of Children$25,000
Return of Mortal Remains$50,000
Local Cremation or Burial$5,000
Natural Disaster Evacuation $5,000
Natural Disaster Daily Benefit$25 per day, 5-day limit
Political Evacuation & Repatriation$10,000
Pre-certification — 25% penaltyRequired inside the United States for specific types of treatment. Penalty does not apply to emergencies.
Accidental Death and Dismemberment (AD&D)Primary Insured or Travel Companion $25,000 Principal Sum Eligible Spouse $10,000 Principal Sum Eligible Dependent Children $5,000 Principal Sum Aggregate limit of $250,000 for total number of insureds on the plan