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2/4/2019 https://quote.hccmis.com/content/studentsecure/help/PolicyHelpStd.htm#diff

BENEFIT ELITE SELECT BUDGET SMART

Maternity care for a Up to $25,000. Up to $10,000. Up to $5,000. No coverage.
covered pregnancy

Nursery care of Up to $750. Up to $250. No coverage.
newborn (not
subject to
coinsurance)

Therapeutic Up to $500. Not subject to coinsurance.
termination of
pregnancy

Outpatient Physical Up to $75 per visit per day Up to $50 per visit per day Up to $25 per
therapy & visit per day
chiropractic care
(Not subject to
coinsurance. Must
be ordered in
advance by a
physician and not
obtained at a student
health center.)

Intercollegiate, Up to $5,000 maximum per injury or illness; Up to $3,000 No coverage.
interscholastic, medical expenses only
intramural, or club maximum per
sports
injury or illness;

medical expenses

only

Terrorism Up to $50,000 lifetime maximum. Eligible medical expenses only. No coverage.

EMERGENCY ELITE Limit SELECT Limit BUDGET Limit SMART Limit
TRAVEL BENEFIT

Emergency medical Up to $500,000 lifetime Up to $300,000 Up to $250,000 Up to $50,000
evacuation (Not maximum lifetime lifetime lifetime
subject to deductible maximum maximum maximum
or coinsurance.)

Emergency Up to $5,000, subject to a maximum of 15 days Up to $1,000, subject to a maximum
reunion(Not subject of 15 days
to deductible or
coinsurance.)

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