more student

Plans Designs

Student Select Summary of Coverage

The following General Summary of features on Fortis Health Student Select Plan may vary according to the state in which the insured resides. This summary is not an insurance contract. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. After purchasing the Student Select plan, read your policy carefully. If you are not satisfied with the plan, return it to Fortis Health or your agent within 10 days after it is delivered. All premiums will then be refunded.

STUDENT SELECT is designed to provide coverage for major hospital, medical and surgical expenses incurred as a result of medically necessary care for a covered illness or injury. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital services, AND out of hospital care, subject to any deductibles or rate of payment provisions or other limitations which may be set forth in the policy.

AUTHORIZATION is required to be eligible to receive the maximum benefits available under the plan. Read the Benefit Management Program provision of your policy carefully.

STUDENT SELECT provides a $100,000 per condition maximum benefit amount and a $1,000,000 lifetime maximum benefit amount. A deductible amount applies each calendar year.

A COVERED CHARGE is the reasonable charge, as determined by Fortis, with respect to charges made by a physician, facility or supplier for covered medical services. In determining whether a charge is reasonable, Fortis will consider the following factors:

The actual charge;
Specialty training, work value factors, practice costs, regional geographic factors and inflation factors;
The negotiated rate with a physician, facility or supplier;
The amount charged for the same or comparable services or supplies in the same region or in other parts of the country; or
Consideration of new procedures, services or supplies in comparison to commonly used procedures, services or supplies. covered medical services must: (1) be prescribed by a physician; (2) be rendered for diagnosis or treatment of the covered personal illness or injury, except as may be specifically noted in the policy; and (3) be medically necessary.

EXTENSION OF BENEFITS: Coverage may be extended if the covered person is confined as an inpatient in a hospital on the date coverage terminates due to an injury sustained or an illness which commenced while the policy was in force. The extension of benefits provision will apply only if the covered person remains confined as an inpatient in a hospital beyond the termination date.

PRE-EXISTING CONDITIONS LIMITATION: No benefits will be paid for any pre-existing condition of a covered person until the covered person has been continuously insured under this plan for 12 months. After such 12-month period, benefits will be paid for a pre-existing condition on the same basis for any other condition. A pre-existing condition is an illness or injury, whether disclosed at the time of application or not: (1) for which the covered person received medical advice, diagnosis, treatment or services from a physician within the 12-month period prior to the covered persons effective date; or (2) that produced signs or manifested symptoms within the 12-month period prior to the covered persons effective date.