318-573-6186
Jing Liu
318-573-6186
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Please use this high level information as a guide only and do not make any decisions solely based on this information. If you have any concerns, doubts or questions, please refer to the individual policy details for complete information, as it is not possible to accurately represent all the details in concise information such as follows, or call us for further details. If there is any discrepancy between this information and the actual policy details, the policy details will override.
All the amounts are in U.S. dollars.
Vision (eyeglasses, etc.) is not covered in any of the plans.
General
Medical - Outpatient
Within the PPO network or outside the U.S.: $50 copay per visit.
Otherwise, $100 copay per visit.
Urgent Care: $50 copay per visit within the PPO network or outside the U.S.
Otherwise, $100 copay per visit.
To policy maximum
In US: $200 copay
50% of actual charges
To policy maximum
To policy maximum
To policy maximum
20% of primary surgeon charge. No standby availability coverage.
To policy maximum
To policy maximum
Medical - Inpatient
To policy maximum, average semi-private room including nursing services.
To policy maximum
To policy maximum
To policy maximum
20% of primary surgeon charge. No standby availability coverage.
To policy maximum
To policy maximum
Medical - Other Treatment And Services
60 days
Standard basic hospital bed and/or standard wheelchair rental up to purchase prices
Recreational: Included. School/Club Sports - $5,000 per injury/illness.
$750 per injury/illness, if covered injury/illness results in hospital admission.
$10,000.
Pregnancy must begin after effective date.
Maximum of 30 days. Cannot be provided at a Student Health Center.
Maximum of 30 visits. Cannot be provided at a Student Health Center.
Included in the Mental & Nervous Disorder benefit
Physical Therapy and Chiropractic Care: $50 per day Must be ordered in advance by a physician.
United Healthcare PPO
Network of physicians, hospitals, urgent cares, labs and other healthcare providers.
No network for pharmacies, dentists, ambulance.
On effective date, $25,000 for Acute Onset only.
After 6 month waiting period, same as any other eligible expense.
$750
$500
-
-
Included
Dental
Travel
-
-
-
$5,000, maximum of 15 days
$300,000
$50,000
-
-
Life
$25,000 Optional: up to $50,000
$25,000 Optional: up to $50,000
Other
-
Incidental: 15 days per 3 month period
Within the PPO network or outside the U.S.: $100 copay per visit. Otherwise, $200 copay per visit.
-
-
-
$50,000 Eligible medical expenses only
Outside Home Country
Plan Features
Before effective date, full refund.
After effective date, must be within first 60 days, pro-rated refund for whole months minus $25 cancellation fee, as long as no claims have been filed since the effective date; form required.
1 month up to 4 years
$0
Optional: Crisis Response Rider $100,000
Email
Postal Mail
Courier
Per Incident
$0 0-64
Per Incident
$500,000 0-64
WorldTrips
Lloyd's
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- For medical benefits, to policy maximum, refer to the Usual, Reasonable and Customary Charges. Deductible and coinsurance apply, unless otherwise noted.
- Whenever there is a difference in benefits levels within PPO network and outside PPO network, the benefits shown above are applicable when availing treatment within PPO network.
- Coverages shown are per person unless noted otherwise.
- The dash (-) in the fields above means Not Applicable (N/A).