Student Medical Plans

Benefits

GeoBlue Navigator has three tiers of coinsurance: 100% outside the U.S., 80% in network in the U.S., 60% out of network inside the U.S. All GeoBlue Navigator plans have an Unlimited Lifetime Maximum and a $250,000 maximum benefit for emergency medical evacuation.

Benefit Maximum

Outside U.S.

In Network, U.S.

Out of Network, U.S.

Lifetime Maximum per Insured Person Unlimited Unlimited Unlimited
Annual Maximum per Insured Person Unlimited Unlimited Unlimited
Preventative and Primary Care Insurer Waives Deductible
Primary Care Office Visits - as many as 8 visits per Calendar Year All except a $10 copay per visit1 All except a $30 copay per visit 60% to Coinsurance Maximum then 100%
Preventative Care For Babies/Children: (Birth through Age 18)
a. Office Visits/examination
b. Immunizations, Lab work & X-rays done in conjunction with an office visit
100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Preventative Care for Adults: (Age 19 and Older)
a. Office Visits/examination
b. Immunizations as recommended on the published Center for Disease Control (CDC) immunization schedule for adults
c. Routine Pap Smears, annual mammogram
d. PSA For Men
e. Diagnostic lab work & X-rays done in conjunction with an office visit
100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Travel Vaccinations, Subject to a Calendar Year Maximum of $500 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Annual Physical Examination/Health Screening, Subject to a Calendar Year Maximum of $250 and limited to one per Calendar Year 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Urgent Care Facility 100% All except a $75 copay per visit 60% to Coinsurance Maximum then 100%
Outpatient Services Insurer Pays After Deductible is Met
Outpatient Medical Care 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Inpatient Hospital Services Insurer Pays After Deductible is Met
Surgery, X-rays, In-hospital doctor visits, Organ/Tissue Transplant 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Inpatient medical emergency6 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Professional Services
Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab work
100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Ambulatory and Therapeutic Services Insurer Pays After Deductible is Met, Unless Noted
Ambulatory Surgical Center 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Physical/Occupational Therapy, Limited to 6 visits per Calendar Year 100%, no deductible 100%, no deductible 100%, no deductible
Ambulance Service 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Acupuncture and Chiropractic Services, Subject to a $2,000 Maximum per Calendar Year if under the care of a licensed Physician 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Durable Medical Equipment 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Rehabilitation and Therapy Insurer Pays After Deductible is Met, Unless Noted
Inpatient Mental Health 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Outpatient Mental Health 100%, no deductible
$10 Copayment1
100%, no deductible
$30 Copayment
60% to Coinsurance Maximum then 100%, no deductible
Inpatient Substance Abuse 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Outpatient Substance Abuse 100%, no deductible
$10 Copayment1
100%, no deductible
$30 Copayment
60% to Coinsurance Maximum then 100%, no deductible
Outpatient Prescription Drugs Insurer Waives Deductible
Prescription Drug Benefit, Subject to $5,000 Maximum per Insured Person per Calendar Year, Maximum 90-day supply 100% of actual charges 100% of actual charges 100% of actual charges
Global Travel Benefits Insurer Waives Deductible
Emergency Medical Transportation Maximum Lifetime benefit for all Evacuations up to $250,000
Repatriation of Mortal Remains Maximum Benefit up to $25,000
Accidental Death and Dismemberment Maximum Benefit: Principal Sum up to $10,000

Plan Deductible Choices

GeoBlue Navigator1,2,3,4,5,6

Deductible

   

Coinsurance Maximum

  Outside U.S. U.S. In Network U.S. Out of Network  
0 $0 $0 $0 $1,000
250 $125 $250 $500 $2,000
500 $500 $500 $500 $3,000
1,000 $500 $1,000 $2,000 $4,000
2,500 $1,250 $2,500 $5,000 $8,000
5,000 $2,500 $5,000 $10,000 $10,000
  1. Copay waived when visiting a GeoBlue contracted provider outside the U.S.
  2. Deductibles are Per Person per Calendar Year.
  3. The Out-of-Pocket Maximum is calculated by adding the deductible and coinsurance maximum together. For a family, the maximum deductible and coinsurance are increased by a factor of 2.5, regardless of the size of the family.
  4. Amounts paid to satisfy a deductible are credited to all other deductibles, both inside and outside the U.S. For example, if you satisfy your Outside U.S. deductible, this amount is credited to the U.S. (In Network) and U.S. (Outside Network) deductible requirements.
  5. An Insured Person only has to satisfy his/her Out-of-Pocket Maximum once a Year for all services received outside of the U.S. and in the U.S.
  6. Emergency room visits that do not result in inpatient admissions will be subject to a $100 penalty.

For Exclusions and Limitations see Plan Description

Ten Day Money Back Guarantee

We are so confident in our products that we offer the best guarantee in the business. If you are not completely satisfied with our product, simply send an email to enrollment@geo-blue.com within 10 days of purchase and include the reason for cancellation.