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ExchangeGuard® Choice - Insurance for J1 Exchange Visitors and F1 Students

Individual

Please use this high level information as a guide only and do not make any decisions solely based on this information. If you have any concerns, doubts or questions, please refer to the individual policy details for complete information, as it is not possible to accurately represent all the details in concise information such as follows, or call us for further details. If there is any discrepancy between this information and the actual policy details, the policy details will override.

All the amounts are in U.S. dollars.

Vision (eyeglasses, etc.) is not covered in any of the plans.

General

ExchangeGuard® Choice
Comprehensive
US - Within PPO/Outside US: After deductible, pays 100% to policy maximum; or After deductible, pays 80% to policy maximum. Otherwise: After deductible, plan pays Usual, Reasonable and Customary to policy maximum.
To policy maximum

Medical - Outpatient

To policy maximum
US-Urgent Care/Walk-in Clinic: Deductible waived, $15 copay; unless $0 deductible. Co-insurance still applies. Outside US: No copay.
To policy maximum In US: Extra $250 copay for illness visit that does not result in hospital admission.
To policy maximum, 60 day supply per prescription.
To policy maximum
To policy maximum
To policy maximum
20% of primary surgeon charge. No standby availability coverage.
To policy maximum
To policy maximum

Medical - Inpatient

To policy maximum, average semi-private room including nursing services.
To policy maximum
To policy maximum
To policy maximum
20% of primary surgeon charge. No standby availability coverage.
To policy maximum
To policy maximum

Medical - Other Treatment And Services

90 days
Standard basic hospital bed and/or standard wheelchair rental up to purchase prices
Recreational: Included
To policy maximum, if covered injury/illness results in hospital admission.
Only the complications of pregnancy, during first 26 weeks of pregnancy.
-
-
-
Physical Therapy and Chiropractic Care: $500 maximum.
United Healthcare PPO
Network of physicians, hospitals, urgent cares, labs and other healthcare providers.
No network for pharmacies, dentists, ambulance.
Yes
After 6 month waiting period, $500 per certificate period.
-
-
-
-
Included

Dental

$300
$300

Travel

$10,000
$50 per item, $1,000 maximum
$50,000
$100,000, maximum of 15 days
$1,000,000
To policy maximum
$5,000
$100,000

Life

Under 18: $5,000, Ages 18-64: $25,000; maximum $250,000 per family or group.
Under 18: $10,000, Ages 18-64: $50,000; maximum $250,000 per family or group.

Other

For every parent insured, one child under age 10 years is free. Maximum 2 children free.
Incidental: U.S. home country: 15 days per 3 month period. Non-U.S. home country: 30 days per 3 month period.
$100 per day
-
$250 per day, 5 day maximum
$25,000
$50,000 Eligible medical expenses only
Outside Home Country

Plan Features

Before effective date, full refund. After effective date, pro-rated refund minus $25 cancellation fee as long as no claims have been filed since the effective date.
5 days up to 4 years
$0
Travel Delay of 12+ hours and unplanned overnight stay - $100/day, 2 days maximum. Emergency Eye Exam - $50 per incident copay, $150 maximum (plan deductible waived). Bedside Visit: $1,500 Pet Return: $1,000 Crisis Response: $10,000 Loss of Passport or Travel Documents: $100
Email
Postal Mail
Courier
Varies
$0 0-64
$100 0-64
$250 0-64
$500 0-64
Per Incident
$100,000 0-64
$250,000 0-64
$500,000 0-64
WorldTrips
Lloyd's
A "Excellent"

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Individual
  • For medical benefits, to policy maximum, refer to the Usual, Reasonable and Customary Charges. Deductible and coinsurance apply, unless otherwise noted.
  • Whenever there is a difference in benefits levels within PPO network and outside PPO network, the benefits shown above are applicable when availing treatment within PPO network.
  • Coverages shown are per person unless noted otherwise.
  • The dash (-) in the fields above means Not Applicable (N/A).
DISCLAIMER: This is a high level description of the insurance plan meant to provide a quick overview. It may not describe all possible scenarios or coverages in all different cases. Please refer to the brochure and the certificate wording for complete details. Even though we have tried our best to accurately describe the plan, if there is any discrepancy between this description and the certificate wording, the certificate wording will prevail.

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