INTERNATIONAL
COMMUNITY SERVICE
VANTAGE
PLAN
UNDERWRITTEN
BY MEGA LIFE & HEALTH INSURANCE COMPANY
Maximum
Benefit
$250,000
(For each Injury or Sickness)
Deductible
$50 at Recognized
Student Health Center
$100 for each Injury or
Sickness Maximum of $500 per person per year
Preferred Provider
Coinsurance
The
Company will pay 80% of Covered
Medical Expenses up to the
Aggregate
Lifetime Maximum of $250,000 per Injury/Sickness
Out of Network Provider
Coinsurance
70% of Usual
& Reasonable Covered Expenses
Pre-Existing
Conditions
6 MONTH WAITING PERIOD
Medical
Evacuation / Repatriation
ASSIST AMERICA
Partial
Plan Highlights
|
In Patient |
|
|
Room
Board/Miscellaneous Charges |
$100 Co-pay 1st
3 days |
|
Nervous Mental
include Drug/Alcohol |
30 days same
as any other illness |
|
Out Patient |
|
|
Nervous Mental
include Drug/Alcohol |
30 Visits $20
Co-pay |
|
Physician
Visit |
$20 Co-pay |
|
Day Surgery
Charges |
$150.00 Co-pay
|
|
Emergency room |
$150 Co-pay
waived if admitted |
|
Xray/Lab/Misc
Test |
$20 Co-pay per
test |
|
MRI/CAT Scan |
$100 Co-pay -
$1200 maximum benefit |
|
Prescription
Drugs (w/Disc Card) |
80% to $2,000.00 |
Premium Rates
Student/Scholar
Annual Monthly*
DEPENDENTS Annual Monthly*
Student UNDER
24
$588.00 $
49.00 Spouse UNDER 24 $ 2,400.00
$
200.00
Student 24-30 $756.00
$
63.00 Spouse
24-30 $ 3,000.00 $ 250.00
Student 31-40 $1,500.00 $125.00 Spouse
31-40
$ 6,000.00 $
500.00
Student 41-50 $2,040.00 $170.00 Spouse
41-50 $ 8,160.00 $ 680.00
Student +51
$4,200.00 $350.00 Spouse +51 $12,600.00 $1,050.00
*3 month
minimum
each Child
$ 1,092.00 $
91.00
For questions
or more information please contact:
Insurance for Students, Inc
600 Corporate Drive #101
Fort
Lauderdale, FL 33334
Phone
800-356-1235
fax
954-772-0872