The Collegiate Care Exclusive Plan is an International Travel Medical and Evacuation & Repatriation Insurance Plan for International Students, Scholars studying or teaching in the US. Student must have a valid F, M, or Q visa. Not Eligible are: F1 visa holder on OPT, Dependents of the eligible person, Green Card Holders, and Students who are US citizens. Covers Interscholastic, Intercollegiate, Intramural and Club sports

Eligible individuals may enroll onto the Plan no earlier than 30 days prior to the start of their classes.

A 3-month minimum purchase required.

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Plan Highlights

  • United Healthcare PPO Network
  • Unlimited medical maximum and lifetime medical maximum
  • $50, $100, or $1,000 Deductible for In Network
  • $100, $200 or $1,500 Deductible Out of Network
  • $0 Student Health Center Deductible
  • Copayments- Physician/Specialist $25; Urgent Care Center $50 Emergency Room Visit $250 Hospital Admission $100
  • Plan covers 90% of the Preferred Allowance
  • Sports Activities Coverage - Interscholastic, Intercollegiate, Intramural and Club
  • Maternity coverage-restrictions may apply
  • Pre-existing Conditions Waiting Period: covered without a Waiting Period
  • COVID-19 EXPENSES are covered and treated as any other sickness

Benefits of Coverage

Medical Benefits
Medical Maximum
Unlimited
  • Coverage Area: Worldwide
  • Home Country Coverage per Period of insurance: $1,000 per Period of Insurance
Deductible
In-Network Provider $50, $100, $1,000 per Insured Person/Out-of-Network Provider $100, $200, $1,500 per Insured Person/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 Visit
  • Urgent Care Center visit Copayment: $50 per Visit
  • Emergency Room Visit Copayment (waived if admitted): $250 per Visit
Co-insurance
90% of Preferred Allowance/ Out of Network Provider 70% Usual & Customary
  • $2,500 per Insured Person per Period of Insurance
  • Unlimited per Insured Person per Period of Insurance
Out-of-Pocket-Maximum per Period of Insurance
The deductible does not apply to the Out-of-Pocket Maximum
  • In-Network: $2,500 per Insured Person
  • Out-of-Network: Unlimited per Insured Person
Emergency Dental
90% 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
90% Preferred Allowance
  • Sudden onset of pain
  • Maximum Benefit per Period of Insurance: $600
Maternity and Prenatal
90% Preferred Allowance
  • Primary Insured: No Waiting Period
Preventative Care and Annual Exams
Newborn to 12 months: 9 visit maximum /100% Preferred Allowance (Student Health Center payable at UCR)/In-Network or Student Health Center Only, no benefits if an Out-of-Network Provider is used
Homeopathic Care and Acupuncture
90% Preferred Allowance
  • Maximum Benefit per Period of Insurance: $500
  • Office visit Copayment applies
Cancer Care and Oncology
90% Preferred Allowance
Kidney Dialysis
90% Preferred Allowance
Durable Medical Equipment
90% UCR
  • a. When purchased by a physician.
  • b. When a written prescription accompanies the claim when submitted.
Alcohol and Substance Abuse
90% Preferred Allowance
  • Rehabilitative treatment only
  • Office visit Copayment applies
Prescription Medications
90% 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
  • Pre-existing Conditions are covered without a Waiting Period
Additional Benefits
Elective Abortion
90% Preferred Allowance
  • Maximum Benefit per Period of Insurance: $1,500
Home Health Care
90% Preferred Allowance
Hospice Care
90% Preferred Allowance
  • Inpatient Maximum Benefit per Period of Insurance: 45 Days
  • Outpatient Maximum Benefit per Period of Insurance: $5,000
Diabetic Medical Supplies
90% UCR
Acquired Immune Deficiency Syndrome (AIDS)
90% Preferred Allowance
Motor Vehicle Accident
90% Preferred Allowance
  • Injuries caused by Accident
Sports and Other Activities
90% Preferred Allowance
  • Injuries arising from Intercollegiate sports-maximum benefit per Period of Insurance $5,000
  • Injuries arising from Intramural and Club sports
Accidental Death & Dismemberment
$30,000 (covers MVA and Passive War)
24/7 Non-Insurance Benefits
Maximum Length of Coverage
Up to 364 days
Maximum Length of Coverage
364 days
Network Provider
United Healthcare (UHC)
Non Insurance Assistance Services
Included
Emergency Evacuation Benefits
Compassionate Care Visit
Maximum Benefit per Period of Insurance: $2,500
Return of Minor Children or Grandchildren
Maximum Benefit per Period of Insurance: $2,500

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.