Medical Expense Benefits - Injury and Sickness

When a covered Injury or Sickness requires treatment by a Physician, the policy will provide benefits for the Usual and Customary Charges for Medically Necessary Covered Medical Expenses, which exceed the deductible per person for each Injury or Sickness. Payment for any Covered Medical Expense will be no more than the Benefit Limit shown for it. The total payable for all Covered Medical Expenses will be no more than the Maximum Benefit Limit per Sickness or Injury. Benefits are subject to the Excess Provision.

Covered Expenses are the Usual and Customary charges for medically necessary services and supplies incurred within 13 weeks from the date of the accident causing the injury or the onset of sickness. Treatment must begin no more than 30 days after the date of the accident or the onset of sickness.

Covered Medical Expenses include:

1. Room and Board Expense: 1) daily semi-private room rate when Hospital Confined; and 2) general nursing care provided and charged for by the Hospital. $1,000/day to 30 days maximum.

2. Hospital Miscellaneous Expenses: 1) while Hospital Confined; or 2) for pre-admission expenses for being Hospital Confined. Benefits will be paid for services and supplies such as: the cost of the operating room; laboratory tests; X-ray examination; anesthesia; drugs (excluding take home drugs) or medicines; therapeutic services and supplies. $500, per day, 30 days maximum.

3. Intensive Care. Additional $525/day to 8 days maximum.

4. Physiotherapy (Inpatient). $35 per visit, 1 visit/day, 12 visits maximum.

5. Surgery: Physician's fees for Inpatient surgery. Payment will be made based upon the surgical schedule as specified in the Schedule of Benefits. Covered medical expenses will be paid under this Inpatient surgery benefit; or under the Outpatient surgery benefit, but not for both. $3,000 maximum.

6. Anesthetist Services: in connection with Inpatient surgery. 25% of Surgery maximum.

7. Assistant Surgeon (Inpatient): 25% of Surgery Maximum.

8. Private Duty Nurse Services: 1) private duty nursing care only; 2) while Hospital Confined; 3) ordered by a licensed Physician; and 4) a Medical Necessity. $500 maximum. General nursing care provided by the Hospital is not covered under this benefit.

9. Physician Visits when Hospital Confined. Benefits are limited to one Physician's visit per day. Benefits do not apply when related to surgery. $60 per visit for Compass World Premium and $50 per visit for Compass World, 1 visit/day, 30 visits maximum. Covered medical expenses will be paid under the Inpatient benefit or under the Outpatient benefit for Physician's Visits but not both.

10. Pre-admission Testing within 7 days before Hospital admission: limited to routine tests such as: complete blood count; urinalysis; and chest X-ray. $900 maximum. If otherwise payable under the policy, major diagnostic procedures such as: cat-scans; NMR's; and blood chemistries will be paid under the "Hospital Miscellaneous" benefit.

11. Mental and Nervous Disorder (Inpatient): the benefits and the maximum amounts are specified in the Schedule of Benefits and are the same as any Sickness. Benefits are limited to one Physician's visit per day.

12. Surgery (Outpatient): Physician's fees for Outpatient surgery. Payment will be made based upon the surgical schedule as specified in the Schedule of Benefits. Covered medical expenses will be paid under this Outpatient surgery benefit; or under the Inpatient surgery benefit, but not both. $3,000 maximum.

13. Day Surgery Miscellaneous (Outpatient): in connection with Outpatient day surgery; excluding non-scheduled surgery and surgery performed in a Hospital emergency room, trauma center, Physician's office, or clinic. Benefits will be paid for services and supplies such as: the cost of the operating room, laboratory tests and X-ray examinations including professional fees, anesthesia, drugs or medicines, therapeutic services and supplies. $1,000 maximum.

14. Anesthetist (Outpatient): in connection with Outpatient surgery. 25% of Surgery maximum.

15. Assistant Surgeon (Outpatient): 25% of Surgery Maximum.

16. Physician Visits (Outpatient): Includes injections administered during visit. Benefits do not apply when related to surgery or Physiotherapy. $60 per visit for Compass World Premium and $50 per visit for Compass World, 1 visit/day, 30 visits maximum. Covered medical expenses will be paid under the Outpatient benefit or under the Inpatient benefit for Physician's visits but not both.

17. Diagnostic X-rays & Lab services (Outpatient): $400 maximum. Cat Scan, PET Scan or MRI up to $250 additional.

18. Medical Emergency Expenses (Outpatient): only in connection with a Medical Emergency as defined. Benefits will be paid for the use of the emergency room and supplies. 75% of Usual and Customary to $300 maximum.

19. Radiation Therapy and or Chemotherapy (Outpatient), $1,000 maximum.

20. Prescription Drugs (Outpatient). $100 maximum.

21. Mental and Nervous Disorder (Outpatient): the benefits and the maximum amounts are specified in the Schedule of Benefits and are the same as any Sickness. Benefits are limited to one Physician's visit per day.

22. Ambulance Service. $400 maximum.

23. Braces and Appliances: 1) when prescribed by a Physician; and 2) a written prescription accompanies the claim when submitted. Replacement braces and appliances are not covered. Braces and appliances include durable, medical equipment which is equipment that: 1) is primarily and customarily used to serve a medical purpose; 2) can with stand repeated use; and 3) generally is not useful to a person in the absence of Injury or Sickness. $1,000 maximum. No benefits will be paid for rental charges in excess of purchase price.

24. Consultant Physician Fees (Inpatient): when requested and approved by the attending Physician. $400 maximum.

25. Dental Treatment: 1) performed by a Physician; and 2) made necessary by Injury to Sound, Natural Teeth. $500 maximum. Routine dental care and treatment to the gums are not covered.

26. Alcoholism/Drug Abuse Treatment: the benefits and the maximum amounts are specified in the Schedule of Benefits and are the same as any Sickness.

27. Maternity (conception must occur while coverage is in force): $7,500 maximum for normal delivery; $10,000 for C-section delivery for Compass World Premium. $5,000 maximum for normal delivery; $7,500 for C-section delivery for Compass World.

28. Benefits are payable only for those Covered Medical Expenses incurred while the policy is in effect for the Insured Person. No benefits are payable for any expenses incurred after the date insurance terminates, except if an Insured Person is hospitalized on the date his insurance terminates. Benefits will continue to be paid until the completion of the hospital stay, but not to exceed a period of 31 days from the termination date, or the Maximum Policy Benefit, whichever occurs first.

29. Any child conceived on or after the effective date and born of insured will be covered under the policy for the first 31 days after birth. Coverage for such child will be for injury or Sickness including medically diagnosed congenital defects, birth abnormalities, prematurity, and nursery care when the child is sick or injured. To continue coverage beyond 31 days, written application and payment of any required premium must be made to International Student Organization and forwarded to the Underwriting Company.

Excess Provision: All benefits shall be in excess of all other valid and collectible insurance and shall apply only when such benefits are exhausted. If an Insured's Injury or Sickness is due to an act or omission of another, benefits payable by this plan are subject to recovery from amounts eventually paid to the Insured by or on behalf of, the other person.

Conformity With State Statutes: Any provision of the Policy which, on its effective date, is in conflict with the statutes of the state in which it is issued, is hereby amended to conform to the minimum requirements of such statutes.

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