The Collegiate Care Elite Plan is an International Travel Medical and Evacuation & Repatriation Insurance Plan for International Students, Scholars, and their families studying or teaching in the US. International full-time students, ages 12-40 years old, enrolled in an associate, bachelor, master, or Ph.D. program at a university or other accredited higher education institution outside of their Home Country. Student must have a valid F, M or Q visa. The spouse, domestic partner, or dependent child(ren) of a Class 1 Insured Person.

Not Eligible: · F1 visa holder on OPT are not eligible. · Green Card Holders · Students who are United States citizens.

Plan Highlights

  • United Healthcare PPO Network
  • Unlimited maximum per Period of Insurance/Unlimited per Lifetime
  • Unlimited medical maximum per lifetime
  • $100, $500 $1,000 per Insured Person in Network
  • $200, $750, $1,500 per Insured Person Out of Network
  • Student Health Center $0 per visit not subject to Deductible
  • Copayments-Physician/Specialist $25; Urgent Care Center $50; Emergency Room Visit $250; Hospital Admission $100
  • Plan covers 80% of the Preferred Allowance
  • Maternity coverage-restrictions apply
  • COVID-19 EXPENSES are covered and treated as any other sickness
  • Pre-existing Conditions Waiting Period: no waiting period for students, dependents covered after 24 months
  • See plan documents for full details

Benefits of Coverage

Medical Benefits
Medical Maximum
Unlimited per Period of Insurance/Unlimited Lifetime Maximum
  • Coverage Area: Worldwide
  • Home Country Coverage per Period of insurance: $1,000
Deductible
In-Network Provider$100, $500 $1,000 per Insured Person, 2x Individual per family/Out-of-Network Provider $200, $750, $1,500 per Insured Person, 2x Individual per family/Student Health Center $0/The Deductible for In-Network does not accrue towards the Out-of-Network Deductible
Copayments
Copayments do not apply to the Deductible or the Out-of-Pocket Maximum
  • Student Health Center Copayment: $0 per Visit
  • Physician/Specialist Office Visit Copayment: $25 per Visit
  • Hospital Copayment per Admission: $100 per Admission
  • Urgent Care Center visit Copayment: $50 per Visit
  • Emergency Room Visit Copayment (waived if admitted): $250 per Visit
Co-insurance
80% of Preferred Allowance/ Out of Network Provider 70% Usual & Customary
  • Student Health Center: Deductibles and Copayments are waived when services are rendered at the Student Health Center and are reimbursed at 100%
Out-of-Pocket-Maximum per Period of Insurance
The Deductible does not apply to the Out-of-Pocket Maximum.
  • In-Network: $6,350 per Insured Person, 2x Individual per family
  • Out-of-Network: Unlimited per Insured Person
Emergency Dental
80% Preferred Allowance
  • Limited to accidental Injury of sound natural teeth sustained while covered
  • Maximum Benefit per Period of insurance: $1,000 up to $250 per tooth
Palliative Dental Care
80% Preferred Allowance
  • Sudden onset of pain
  • Maximum Benefit per Period of Insurance: $600
Maternity and Prenatal
80% Preferred Allowance
  • Primary Insured: No Waiting Period
  • Dependent Spouse: Conception must occur at least 10 (ten) months after the Effective Date
Preventative Care and Annual Exams
Maximum Benefit per Period of Insurance $1,000/ 100% Preferred Allowance/Student Health Center payable at UCR)
  • Newborn to 12 months: 9 visit maximum
  • Child/Adult Annual exams and Immunizations- Covered (see plan details)
  • No benefits if an Out-of-Network Provider is used
Homeopathic Care and Acupuncture
80% Preferred Allowance
  • Maximum Benefit per Period of Insurance: $500
  • Office Visit Copayment applies
Cancer Care and Oncology
80% Preferred Allowance
Kidney Dialysis
80% Preferred Allowance
Durable Medical Equipment
80% UCR/Reimbursement of rental up to the purchase price
  • a. When purchased by a physician.
  • b. When a written prescription accompanies the claim when submitted.
Alcohol and Substance Abuse
80% Preferred Allowance
  • Rehabilitative treatment only
  • Office visit Copayment applies
Prescription Medications
80% of charges/$10 Copayment per prescription for Tier 1 ~$20 Copayment per prescription for Tier 2 ~ 60% Coinsurance per prescription for Tier 3
  • Up to 31-day supply per prescription
  • Includes oral contraceptives
  • Network pharmacy is required
  • Coinsurance does not apply to the Out-of-Pocket Maximum
Medical Evacuation and Repatriation of Remains Benefit
Included
Telemedicine
Covered - must use teladoc provider listed in plan documents
Pre-Existing Conditions Benefits
Pre-Existing Conditions Look Back Period
12 Months Lookback Period
  • Student: Pre-existing Conditions are covered without a Waiting Period
  • Dependents: Pre-existing Conditions are covered after a 24 month Waiting Period
Additional Benefits
Elective Abortion
80% Preferred Allowance
  • Maximum Benefit per Period of Insurance: $1,500
Home Health Care
80% Preferred Allowance
Hospice Care
80% Preferred Allowance Inpatient Maximum Benefit per Period of Insurance: 45 Days Outpatient Maximum Benefit per Period of Insurance: $5,000
Diabetic Medical Supplies
80% UCR
Acquired Immune Deficiency Syndrome (AIDS)
80% Preferred Allowance
  • Human Immunodeficiency Virus (HIV+), AIDS Related Complex (ARC), Sexually transmitted diseases and all related conditions
Motor Vehicle Accident
80% Preferred Allowance
Sports and Other Activities
80% Preferred Allowance
Accidental Death & Dismemberment
$30,000 (covers MVA, Self-Inflicted, Mental Health and Passive War)
Emergency Evacuation Benefits
Compassionate Care Visit
$2,500 per Period of Insurance
Return of Minor Children or Grandchildren
$2,500 per Period of Insurance
24/7 Non-Insurance Benefits
Maximum Length of Coverage
Up to 364 days
Network Provider
United Healthcare (UHC)
Non Insurance Assistance Services
Included

In the event that you are dissatisfied and wish to make a complaint, you can do so at: complaints@trawickinternational.com

Sanctions Limitations Clause

The Insurer will not provide any cover, pay any claim or provide any benefit under this Plan to the extent that the provision of such cover, the payment of such claim or the provision of such benefit would expose them to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.

Disclosure Details

This plan summary contains a description of the insurance benefits provided by the insurance plan you have purchased. The coverage is provided by a group insurance policy issued to the AMD Global Trust by Zurich Insurance Europe AG, Belgian branch. By purchasing this coverage, you have become a participant in the AMD Global Trust and a copy of the subscription agreement is contained herein. Please keep this summary as an explanation of the benefits available. This summary is not intended to be a contract of insurance. Complete provisions pertaining to the insurance coverage are contained in the policy. In the event of any conflict between this plan summary and the policy, the policy will govern. The policy is not designed to cover US citizens or residents, and it is not subject to guaranteed issue or renewal. This insurance is not subject to and does not provide certain insurance benefits required by the United States’ Patient Protection and Affordable Care Act (“PPACA”).

Insurance coverage is not subject to and does not provide certain insurance benefits required by the United States’ Patient Protection and Affordable Care Act (“PPACA”). PPACA requires certain US citizens or US residents to obtain PPACA compliant health insurance, or “minimum essential coverage.” In some cases, certain individuals may be deemed to have minimum essential coverage under PPACA even if their insurance coverage does not provide all of the benefits required by PPACA. You should consult your attorney or tax professional to determine whether the policy meets any obligations you may have under PPACA.

Privacy Statement. We know that privacy is important to you and we strive to protect the confidentiality of non-public personal information. We do not disclose any non-public personal information about our insureds or former insureds to anyone, except as permitted or required by law. We maintain appropriate physical, electronic and procedural safeguards to ensure the security of non-public personal information. You can find a copy of our Privacy Policy here: https://www.trawickinternational.com/privacy-policy/ and Privacy Policy | SureGo Administrative Services (mysurego.com)

Data Protection. Please note that sensitive health and other information that is provided to us may be used by us, our representatives, the insurers and industry governing bodies and regulators to process the insurance, handle claims and prevent fraud. This may involve transferring information to other countries (some of which may have limited, or no data protection laws). We have taken steps to ensure the information is held securely. Where sensitive personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates, both to the disclosure of such information to us and its use as set out above. Information we hold will not be shared with third parties for marketing purposes. Insureds have the right to access their personal records.

By purchasing this insurance provided by Zurich Insurance Europe AG, Belgian branch, you agree to subscribe and become a participant in the AMD Trust and understand that participation in the Trust is a prerequisite to procuring the insurance coverage.