| Benefit |
LewerMark $50,000 |
LewerMark $100,000 |
LewerMark $250,000 |
| Maximum Per Accident or Sickness |
$50,000 |
$100,000 |
$250,000 |
| Annual Maximum |
$50,000 |
$100,000 |
$250,000 |
| Lifetime Maximum |
Unlimited |
Unlimited |
Unlimited |
| Deductible per Accident or Sickness |
$100; $50 if referred by
Student Health Center |
$50; $20 if referred by
Student Health Center |
$50; $20 if referred by
Student Health Center |
| Coinsurance |
100% |
100% |
100% |
| Emergency Room Visit (If not admitted or not an emergency) |
$50 Additional Deductible |
$50 Additional Deductible |
$50 Additional Deductible |
| Outpatient Prescriptions |
100% at Student Health Center;
50% at retail pharmacy |
100% at Student Health Center;
50% at retail pharmacy |
100% at Student Health Center;
50% at retail pharmacy |
| "Plus" Benefits:Routine PAP & Mammogram |
N/A |
N/A |
Included |
| Medical Evacuation* |
Unlimited benefit through Assist America, and $50,000 under terms of Policy |
Unlimited benefit through Assist America, and $50,000 under terms of Policy |
Unlimited benefit through Assist America, and $50,000 under terms of Policy |
| Repatriation* |
Unlimited benefit through Assist America, and $25,000 under terms of Policy |
Unlimited benefit through Assist America, and $25,000 under terms of Policy |
Unlimited benefit through Assist America, and $25,000 under terms of Policy |
| Intercollegiate Sports Benefit |
Up to $10,000 per accident |
Up to $10,000 per accident |
Up to $10,000 per accident |
| Mental Nervous / Substance Abuse |
10 inpatient days per year; 3 outpatient visits per year |
10 inpatient days per year; 3 outpatient visits per year |
10 inpatient days per year; 3 outpatient visits per year |