| Opal Plan | Platinum | Blue Diamond | |
|---|---|---|---|
| Price/30 days |
$90.00
$500 ded.
|
$114.90
$1500 ded.
|
$133.50
$250 ded.
|
| PPO Network | UnitedHealthcare | UnitedHealthcare | UnitedHealthcare |
| Maximum Benefit | Unlimited | Unlimited | Unlimited |
| Deductible at SHC | $500 | No Deductible | $250 |
| Copayment at SHC | No Copayment | No Copayment | No Copayment |
| Co-Insurance | 80% | 80% | 80% |
| Physician Visits | $30 copay | $25 copay | $30 copay |
| Urgent Care | $50 copay | $50 copay | $50 copay |
| Emergency Room Visits | $300 copay | $500 copay | $250 copay |
| Prescription Drugs | $30 copay, 80% Charges | $20 copays/$40 copays / 60% co-insurance | 80% with $30 copay |
| Preventive Care | 100% In-Network | 100% In-Network | 100% In-Network |
| Pre-existing Condition | No Waiting Period | No Waiting Period | No Waiting Period |
| Out-of-Pocket Maximum | $6,350 In-Network | $6,350 In-Network | $6,350 In-Network |
| Maternity | 80% | 80% | 80% |
| Mental Health | 80% | 80% | 80% |
| Intramural, Club & Recreational Sports | ✓ | ✓ | ✓ |
| Pediatric Dental/Vision | ✘ | ✓ | ✘ |
| Medical Evacuation & Repatriation | ✓ ($100,000 Max) | ✓ | ✓ ($100,000 Max) |
| Return of Mortal Remains | ✓ ($50,000 Max) | ✓ | ✓ ($50,000 Max) |
| Worldwide Coverage | ✓ (except Home Country) | ✓ (except Home Country) | ✓ (except Home Country) |