Student Travel Insurance by Seven Corners

Schedule of Benefits

All coverages and plan costs are shown in United States dollar amounts and are per person and period of coverage unless otherwise noted.

Liaison Student Economy

Liaison Student Choice

Liaison Student Elite

Plan Options

Coverage Length

5 days to 364 days Renewable as long as primary participant is eligible.

Coverage Area

Worldwide including & excluding the U.S.

Lifetime Medical Maximum

$5,000,000

Medical Maximum Options - per person per disablement

Ages 14 days to 64: $50,000; $100,000; $250,000; $500,000; $1,000,000

Deductible Options - per person per disablement
you pay

$0, $50, $100, $250, $500, $1,000

Student Health Centers
you pay

$5 copay per visit; (not subject to deductible)

Coinsurance Options Outside the United States
the plan pays

100% to the medical maximum.

Coinsurance Options Inside the United States
the plan pays

IN PPO NETWORK
We pay 80% of the first $5,000, then 100% to the medical maximum. OUT OF PPO NETWORK
We pay 70% of the first $5,000, then 100% to the medical maximum.

IN PPO NETWORK
We pay 90% of the first $5,000, then 100% to the medical maximum. OUT OF PPO NETWORK
We pay 80% of the first $5,000, then 100% to the medical maximum.

IN PPO NETWORK
We pay 100% to the medical maximum. OUT OF PPO NETWORK
We pay 90% of the first $5,000, then 100% to the medical maximum.

MEDICAL

Inside the United States failure to get pre-certification for treatment will result in a 25% penalty; penalty does not apply to emergencies.

Hospital Room & Board, Inpatient Hospital Services, Outpatient Hospital/Clinic Services, Emergency Room, Doctor's Office Visits

Usual, Reasonable and Customary to the medical maximum.

Prescription Drugs

INSIDE THE UNITED STATES
$10 copay for generic/$20 copay for brand name (not subject to the deductible)

OUTSIDE THE UNITED STATES
$0 copay (deductible applies)

INSIDE THE UNITED STATES
$5 copay for generic/$10 copay for brand name (not subject to the deductible)

OUTSIDE THE UNITED STATES
$0 copay (deductible applies)

INSIDE THE UNITED STATES
$0 copay (not subject to the deductible)

OUTSIDE THE UNITED STATES
$0 copay ((deductible applies)

Vaccinations (in the U.S. only as required by school, university or visa program)

$100 per 364 days of continuous coverage

$150 per 364 days of continuous coverage

$200 per 364 days of continuous coverage

Physical Therapy

$25 per day to a max of 60 days

$50 per day to a max of 60 days

$75 per day to a max of 60 days

Spinal Manipulation

$25 per day to a max of 60 days (if prescribed by a physician for pain relief)

$50 per day to a max of 60 days (if prescribed by a physician for pain relief)

$75 per day to a max of 60 days (if prescribed by a physician for pain relief)

Local Ambulance Benefit

INSIDE THE UNITED STATES
$350 per disablement (injury/illness)

OUTSIDE THE UNITED STATES
Up to medical maximum

INSIDE THE UNITED STATES
$500 per disablement (injury/illness)

OUTSIDE THE UNITED STATES
Up to medical maximum

INSIDE THE UNITED STATES
$750 per disablement (injury/illness)

OUTSIDE THE UNITED STATES
Up to medical maximum

Coma Benefit

$10,000 (separate from the medical maximum)

$25,000 (separate from the medical maximum)

$50,000 (separate from the medical maximum)

Extension of Benefits to Home Country

$1,000

$5,000

$10,000

Incidental Trips to Home Country (for minimum purchases of 30 days)

$1,000

$5,000

$10,000

Waiver of Pre-existing Conditions

After a waiting period of 364 days of continuous coverage, pre-existing conditions are covered as any other disablement.

Acute Onset of a Pre-existing Condition (during the initial 364 days of coverage)

Medical covered expenses up to $5,000

Medical covered expenses up to $10,000

Medical covered expenses up to $25,000

Mental Illness including Alcohol & Substance Abuse

Inpatient: $5,000 (45 days max) Outpatient: 80% of URC to $500

Inpatient: $10,000 (45 days max) Outpatient: 80% of URC to $1,000

Inpatient: $20,000 (45 days max) Outpatient: $2,000

Motor Vehicle Accident

Inside the United States 50% up to $100,000 Outside the United States Up to medical maximum

Inside the United States 75% up to $100,000 Outside the United States Up to medical maximum

Inside the United States 100% up to $100,000 Outside the United States Up to medical maximum

Non-contact Amateur Sports

$2,500

$5,000

$10,000

Maternity Care For a pregnancy to be covered, conception must occur 180 days after coverage begins.

$500
Benefits reduced 25% for failure to notify us within the first 90 days of pregnancy.

INSIDE THE UNITED STATES
In PPO Network: 80% up to $10,000 Out of PPO Network: 60% up to $10,000 OUTSIDE THE UNITED STATES 80% up to $10,000

Benefits reduced 25% for failure to notify us within the first 90 days of pregnancy.

INSIDE THE UNITED STATES
In PPO Network: 80% up to $25,000 Out of PPO Network: 60% up to $25,000 OUTSIDE THE UNITED STATES 80% up to $25,000

Benefits reduced 25% for failure to notify us within the first 90 days of pregnancy.

Routine Newborn Care

$250 per newborn child

$500 per newborn child

$750 per newborn child

DENTAL

Dental - Sudden Relief of Pain (for minimum purchases of 30 days)

$150

$250

$350

Dental - Accident

$500

$1,000

$2,500

Emergency Services and Assistance

Emergency Medical Evacuation & Repatriation

$100,000 (separate from the medical maximum)

$500,000 (separate from the medical maximum)

$750,000 (separate from the medical maximum)

Emergency Medical Reunion

Up to $200 per day/$15,000 maximum

Up to $200 per day/$25,000 maximum

Up to $200 per day/$50,000 maximum

Return of Child(ren)

$25,000

$40,000

$50,000

Return of Mortal Remains

$50,000

Local Burial/Cremation

$5,000

Natural Disaster Evacuation

$5,000

$10,000

Natural Disaster Daily Benefit

$25 per day, 5-day limit

$50 per day, 5-day limit

$75 per day, 5-day limit

Political Evacuation & Repatriation

$10,000

Felonious Assault

$10,000 (separate from the medical maximum)

$15,000 (separate from the medical maximum)

$20,000 (separate from the medical maximum)

Terrorism

$25,000

$50,000

$100,000

24/7 TRAVEL ASSISTANCE SERVICES

Included

AD&D

Accidental Death and Dismemberment (AD&D)

$25,000 for primary participant; $10,000 for plan participant spouse; $5,000 for plan participant child; Aggregate limit of $250,000 for total number of insureds on plan

Personal liability

$25,000

$50,000

$100,000

Optional Coverage

Hazardous Activities

Up to medical maximum

How it works

Once you complete your purchase, you will immediately receive a receipt, a summary of your benefits, an ID card, and a copy of the Certificate of Insurance. The certificate is the legal document that explains how your coverage works and describes all benefits and exclusions. We recommend you read your insurance certificate, so you understand how your Liaison Student insurance plan works.

UNDERWRITER

You can feel confident with Liaison Students’ strong financial backing through Certain Underwriters at Lloyd’s, London an established organization with an AM Best rating of A (Excellent). Your coverage will be there when you need it.

ADMINISTRATOR

Seven Corners¹will handle your insurance needs from start to finish. We will process your purchase, provide all documents, and handle any claims. In addition, our own 24/7 in-house travel assistance team, Seven Corners Assist, will handle your emergency or travel needs.

¹Seven Corners operates under the name, Seven Corners Insurance Services, in California.

LENGTH OF COVERAGE

Coverage Length – Your coverage length may vary from 5 days to 364 days and is renewable as long as the primary participant is eligible for the plan.

Effective Date – This is the start date of your plan, on the later of the following: 1) 12 a.m. the day after we receive your application and correct payment if you apply online or by fax; 2) 12 a.m. the day after the postmark date of your application and correct payment if you apply by mail; 3) The moment you depart your home country; or 4) 12 a.m. on the date you request on your application.

Expiration Date – The date coverage for you terminates, which is the earliest of the following: 1) The moment you return to your home on the date of attainment of the maximum period of coverage; 2) 11:59 p.m. on the date shown on your ID card; 3) 11:59 p.m. on the date that is the end of the period for which the Plan premium has been paid; or 4) The moment you fail to be eligible.

All times above refer to United States Eastern Time.

EXTENDING YOUR COVERAGE

You can extend coverage as long as the primary participant is eligible for the plan. If you initially buy less than 364 days of coverage, you may buy additional time, from a minimum of 5 days to a total of 364 days. We will email you a renewal notice before your coverage expires, giving you the option to renew your plan. A $5 administrative fee is charged for each renewal.

When we receive your payment for the extension, we will extend your plan’s expiration date. A new coinsurance will apply beginning the 365th day of continuous coverage and beginning each additional 365th day thereafter.

Your original effective date is used to determine if the lifetime medical maximum amount has been reached and to determine pre-existing conditions.

REFUND OF PREMIUM/CANCELLATION

We will refund your payment if we receive your written request for a refund before your effective date of coverage. If your request is received after your effective date, the unused portion of the plan cost may be refunded minus a $25 cancellation fee, if you have not submitted any claims to Seven Corners. Please send your written request for cancellation to policy@sevencorners.com.

PRE-CERTIFICATION

The following expenses must always be pre-certified in the U.S. only:

Outpatient surgeries or procedures;
Inpatient surgeries, procedures, or stays including those for rehabilitation;
Diagnostic procedures including MRI, MRA, CT, and PET Scans;
Chemotherapy;
Radiation therapy;
Physical and occupational therapies;
Home infusion therapy.

To comply with the pre-certification requirements, you must:

Contact Seven Corners Assist before the expense is incurred;
Comply with Seven Corners Assist’s instructions;
Notify all medical providers of the pre-certification requirements and ask them to cooperate with Seven Corners Assist.

Once we pre-certify your expenses, we will review them to determine if they are covered by the plan. Failure to comply with pre-certification requirements

If you do not comply with the pre-certification requirements or if the expenses are not pre-certified, we will review the expenses to determine if they are covered by the plan. If covered:

Eligible medical expenses will be reduced by 25%; and
The deductible will be subtracted from the remaining amount; and
Coinsurance will be applied.

Pre-certification does not guarantee benefits – Pre-certification does not guarantee coverage for, or payment of expenses.

Exclusions

Pre-Existing Condition(s) except as waived for Waiver of Pre-existing Conditions, Acute Onset of Pre-existing Conditions, Emergency Medical Evacuation and Repatriation, Emergency Medical Reunion, Return of Mortal Remains, and Local Burial or Cremation;
Claims not received by the Company or Administrator within ninety (90) days of the date of service:
Treatment that (i) exceeds Usual, Reasonable, and Customary Expenses; (ii) is Investigational, Experimental, or for research purposes; or (iii) received in a Hospital emergency room visit that is not a Medical Emergency;
Treatment, services, or supplies that are not administered by or under the supervision of a Physician or Surgeon and products that can be purchased without a Physician’s or Surgeon’s prescription;
Routine physicals, inoculations, or other examinations or tests conducted when there is no objective indications or impairments in normal health;
Chiropractic care unless specifically provided for in the Plan or acupuncture;
Services, supplies, medications, testing, or Treatment prescribed, performed, or provided by a Relative or Immediate Family Member;
Durable medical equipment;
False teeth, dentures, dental appliances, dental expenses, normal ear or hearing tests, hearing aids, hearing implants, eye refractions, eye examinations for prescribing corrective lenses or eye-glasses unless caused by Accidental Injury, eyeglasses, contact lenses, or eye surgery when the primary purpose is to correct nearsightedness, farsightedness, or astigmatism;
Replacement of artificial limbs, eyes, larynx, and orthotic appliances;
Custodial Care, Educational or Rehabilitative Care, or any Treatment in any establishment for the care of the aged;
Vocational, occupational, sleep, speech, recreational, or music therapy;
Pregnancy, unless a Covered Pregnancy, and Illness or complications from Pregnancy, childbirth, abortion, miscarriage including that resulting from an Accident, postnatal care, preventing conception or childbirth, artificial insemination, infertility, impotency, sexual dysfunction, or sterilization or reversal thereof;
Sleep apnea or other sleep disorders;
Mental and Nervous Disorder unless specifically provided for in the Plan, Rest Cures, learning disabilities, attitudinal disorders, or disciplinary problems;
Congenital abnormalities and conditions arising out of or resulting there- from.
Temporomandibular joint; 18. Occupational Diseases;
Exposure to non-medical nuclear radiation or radioactive materials;
Sexually-transmitted diseases, venereal diseases, and conditions and any consequences thereof;
Acquired Immune Deficiency Syndrome (AIDS), AIDS-Related Complex (ARC), or the Human Immunodeficiency Virus (HIV);
Human organ or tissue transplants.
Exercise programs whether prescribed or recommended by a Physician or therapist;
Weight reduction programs or the surgical Treatment of obesity including, but not limited to, wiring of the teeth and all forms of intestinal bypass Surgery;
Cosmetic or plastic Surgery including deviated nasal septum; modifications of Your physical body intended to improve Your psychological, mental, or emotional well-being including, but not limited to, sex-change Surgery;
Acne, moles, skin tags, disease of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of the sebaceous glands, hypertrophic and atrophic
conditions of skin, nevus;
Hazardous Activities unless You purchase optional hazardous activities coverage and then only for the activities covered under that option under Optional Coverage – Hazardous Activities;
Injuries sustained while participating in professional Athletics, amateur Athletics, intercollegiate Athletic or interscholastic Athletics unless specifically provided for in the Plan including, but not limited to, events, games, matches, practice, training camps, sport camps, conditioning, and any other activity related thereto but excluding non-competitive, recreational, or intramural activities;
Any Illness or Injury sustained while participating in an athletic activity that is sponsored or sanctioned by the National Collegiate Athletic Association (and/ or any other collegiate sanctioning or governing body), or the International Olympic Committee;
Abuse, misuse, illegal use, overuse, dependency upon, or being under the influence of alcohol, drugs, chemicals, or narcotic agents unless administered under the advice of a Physician and taken in accordance with the proper dosing as directed by the Physician;
Suicide or any attempt thereof; self-destruction or any attempt thereof; or any intentionally self-inflicted Injury or Illness;
Terrorist Activity except as provided under Section Terrorist Activity, War, Hostilities, or War-Like Operations;
Commission of a criminal offense or any other criminal or illegal activity as defined by the local governing body;
You unreasonably fail or refuse to depart a country or location following the date a warning to leave that country or location is issued by the United States government or similar warnings issued by other appropriate authorities of either Your Host Country or Your Home Country;
Service in the military, naval, coast guard, or air service of any country or while on duty as a member of a police force or unit;
Treatment paid for or furnished under any other individual, government, or group policy or Expenses incurred at no cost to You;
You while in Your Home Country unless covered under Extension of Benefits in Home country and Incidental Trips to Home Country;
Conditions for which travel was undertaken to seek Treatment after Your Physician has limited or restricted travel;
Travel accommodations;
Injury sustained while You are riding as a pilot, student pilot, operator, or crew member, in or on, boarding or alighting, from any type of aircraft;
Injury sustained while You are riding as a passenger in any aircraft (i) not having a current and valid Airworthy Certificate and (i) not piloted by a person who holds a valid and current certificate of competency for piloting such aircraft;
Flying in any aircraft being used for acrobatic or stunt flying, racing, endurance tests, rocket-propelled aircraft, crop dusting or seeding or spraying, firefighting, exploration, pipe or power line inspection, any form of hunting or herding, aerial photography, banner towing, or any experimental purpose; and
Participating in contests of speed or riding or driving in any type of competition.
Loss of life;
Long-term disability;
Financial guarantee, financial default, bankruptcy, or insolvency risks;
Charges for pre-natal care, delivery, post-natal care, and care of Newborns, unless they are for a Covered Pregnancy;
Injury sustained or Disablement due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with the proper dosing as directed by a Physician;
Injury sustained as the result of You operating a Motor Vehicle while not properly licensed to do so in the jurisdiction in which the Motor Vehicle Accident takes place.

Warnings

GEOGRAPHIC RESTRICTIONS

State Restrictions – We cannot accept an address in Maryland, Washington, New York, South Dakota, and Colorado.

Country Restrictions – We cannot accept an address in Australia, Switzerland, Islamic Republic of Iran, Syrian Arab Republic, United States Virgin Islands, Gambia, Ghana, Nigeria, and Sierra Leone.

We also cannot accept an address in Alberta and Manitoba, Canada. If you live in a Canadian province other than Alberta and Manitoba, please call your agent or Seven Corners to purchase a plan.

Destination Restrictions – We cannot cover trips to Islamic Republic of Iran and Syrian Arab Republic.

Disclaimer – The information provided on this website is intended as a brief summary of benefits and services. It is not your plan document. If there is any difference between the website and your plan document, the provisions of the plan document will prevail. Benefits and premiums are subject to change.

Who can buy a Liaison Student plan?

You may buy a plan for yourself, your spouse and dependents if you are:

A full-time student, faculty member, or scholar;
Involved in full-time educational or research activities;
Traveling outside your home country;
Listed first on the policy as the primary insured.
Non-U.S. citizens traveling to the United States
You must also have a J-1, H-3, F-1, M-1, or Q-1 visa or similar visa or participate in an OPT program.
Non-U.S. citizens traveling outside the United States and U.S. citizens traveling outside the United States
You must have a valid visa if required by your host country.

File a Claim

Complete and sign the appropriate Proof of Loss form:
Medical Claim — English, Français, Español, Português, 中文, 한국어
Baggage Claim – English, Español
Attach required documents:
- Your passport — we need this to verify your travel history and identity.
- Your visa with entry and exit stamps (for non-U.S. citizens traveling to the United States) — This verifies the primary insured (the person listed first on the student policy) is a student and has a valid J-1, H-3, F-1, M-1, or Q-1 or other similar visa.
- An I-20 or DS-2019 (for non-U.S. citizens traveling to the United States) – These documents list the name of the enrolled student and the institution they are attending. It also outlines the start and end date of educational activity, which may also include OPT status and duration.
- Proof of student status – You should always provide this with your claim. This could include:
  - an official/unofficial transcript
  - class schedule for the term when you received the medical treatment related to your claim
  - official letter from your school or institution stating your status for the term in question and verifying if you were enrolled full-time or part-time
Submit all of the documents using one of these methods:
- File upload »
- Email claims@sevencorners.com
- Fax (+01) 317-575-2256
- Mail Seven Corners, Inc.
  Attn: Claims
  303 Congressional Boulevard
  Carmel, IN 46032 USA
After we review your claim, we will let you know if you need to submit the following forms:
Physician's Statement — English
Payment Authorization – English, Español
Authorization of Use and Disclosure of Personal Health Information (PHI) – English

Group Travel

Group Requirements

All group members must be traveling outside the country where you have your true, fixed and permanent home to which you will return.

Your group must have 5 or more travelers, who are not family members.

If your group is planning multiple trips, please complete a separate application form for each group trip.

Get Travel Insurance for your Group

Resources

Contact Us

Our Promise to You

Don’t worry! With our money back pledge, you can cancel your coverage if you are not completely satisfied. A full refund is provided if you send us a written request for a refund before your coverage begins.

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Liaison® Student Series

Specialized Health Insurance Plans for Students, Faculty, Scholars, and their Families

Why do I need student travel insurance?

Who can buy a Liaison Student plan?

Schedule of Benefits

Liaison Student Economy

Liaison Student Choice

Liaison Student Elite

Plan Options

MEDICAL

DENTAL

Emergency Services and Assistance

AD&D

Optional Coverage

How it works

UNDERWRITER

ADMINISTRATOR

LENGTH OF COVERAGE

EXTENDING YOUR COVERAGE

REFUND OF PREMIUM/CANCELLATION

PRE-CERTIFICATION

Exclusions

Warnings

GEOGRAPHIC RESTRICTIONS

Who can buy a Liaison Student plan?

File a Claim

Group Travel

Group Requirements

Resources

Contact Us

Our Promise to You

24/7 Travel Assistance

1-800-690-6295

317-818-2809 (collect)

Document Identifier:	SC_CORP_OnlineCookie_POL
Date Documented:	8 March 2016
Affected Groups:	Marketing
Document Owner:	Corporate Compliance Manager
Document Verified By:	VP Marketing; Corporate Attorney
Document Version:	1.0