Liaison Student Travel Insurance

All Coverages and Benefits are in U.S. Dollar Amounts Unless otherwise mentioned, deductibles, co-pays, coinsurance and benefits are considered on a Per Injury/Sickness basis.

Schedule of Benefits and Limits
Accident and Sickness Medical Maximums Lifetime $250,000 Primary Insured
$50,000 Spouse/Child
Deductible – Per Injury or Illness Non U.S. Students:
$100 if not first treated by the Student Health Center (or if there is no Student Health Center)
$50 if first treated by the Student Health Center
US Citizens: Options: $50 / $0
Co Pay – Per Written Prescription of Medicine Non U.S. Students:
$10 for Generic and $20 for Brand Name
US Citizens:
$0 for Generic and $0 for Brand Name
Coinsurance Plan 1: 80% to $10,000, then 100% to plan maximum
Plan 2: 100% to plan maximum
Benefit Period Covered Expenses incurred during the Period of Coverage
Unexpected Recurrence of a Pre-Existing Condition Non U.S. Students: N/A
US Citizens: Up to $500
Maternity Covered as any other illness
Mental Illness Inpatient: Payable at 50%, up to $10,000 up to a max of 40 days
Outpatient: Payable at 80% , up to $500
Alcohol and Drug Abuse Inpatient/Outpatient: Payable at 50%, up to $1,000
Injuries from a Motor Vehicle Accident Non U.S. Students: $10,000
US Citizens: Up to Policy Maximum
Sports-related Injuries Non U.S. Students: $5,000
US Citizens: Up to Policy Maximum
Dental (emergency) $250 per tooth to a maximum of $500
Emergency Medical Evacuation $100,000
Repatriation of Mortal Remains $25,000
Emergency Reunion $5,000
Accidental Death & Dismemberment $10,000 per Insured
$5,000 per Spouse/Dependent Child
Physiotherapy $500
Spinal Manipulation $500
Ambulance Service $350
Home Country Coverage –
Incidental trips to the Insured’s Home Country
30 days of coverage up to a maximum of  $1,000 during period of coverage
Home Country Extension of Benefits Up to $1,000, expenses must be incurred within 30 days of returning to your Home Country during period of coverage
Assistance 24 hours – Worldwide

Patient Protection and Affordable Care Act (“PPACA”): This insurance is not subject to, and does not provide certain of the insurance benefits required by, the United States PPACA. PPACA requires certain U.S. residents and citizens to obtain PPACA compliant insurance coverage. In certain circumstances penalties may be imposed on U.S. residents and citizens who do not maintain PPACA compliant insurance coverage. You should consult your attorney or tax professional to determine if PPACA’s requirements are applicable to you. The policy contains the plan benefits, including a lifetime maximum that you have selected. Please review your choices to ensure that you have sufficient coverage to meet your medical needs.