Plan name | Age range | Price |
| Violet Exclusive Plan | 17-24 | $876.00 |
| 25-27 | $1,113.25 | |
| 28-29 | $1,361.45 | |
| 30-45 | $2,226.50 |
Network: UHC PPO (1.2M+ providers) Tier: Standalone (single tier; not part of a multi-deductible family) Minimum coverage: Full academic year, or minimum 6 months if purchased for Spring/Summer only
Eligibility
- Age 17 to attained age 45 at time of application
- Non-U.S. citizen
- Full-time undergraduate or graduate student
- Must hold valid passport + valid F-1, M-1, or J-1 visa + valid I-20 or DS-2019
- F-1 visa holders on OPT are not eligible
- Must reside outside Home Country
- Must not hold U.S. residency status
- Plan must be purchased for the full academic year, or a minimum of 6 months if purchased only for Spring/Summer semester coverage
Plan Characteristics
- Deductible: $1,250 in-network / $1,500 out-of-network
- $100 hospital admission copay, in addition to standard coinsurance
- 24/7 ConciergeCare — multilingual support for care, benefits, appointments
- Worldwide coverage excluding Home Country (M1/M2 visa holders not eligible for worldwide coverage outside the U.S.)
- UnitedHealthcare Options PPO network — 1.2M+ providers, 6,500+ hospitals, 643 Centers of Excellence
- No pre-existing condition limitation for students under this plan
- Prescription medication and contraceptives included
Cost Sharing Overview
Deductible
| In-Network | Out-of-Network | |
|---|---|---|
| Deductible | $1,250 | $1,500 |
In-Network and Out-of-Network deductibles accrue separately. Copayments do not apply toward the deductible.
Copayments
| Service | In-Network | Out-of-Network |
|---|---|---|
| Student Health Center | $0 | $0 |
| Office Visit | $30 per visit | $30 per visit |
| Urgent Care | $50 per visit | $50 per visit |
| Hospital Emergency Room | $250 (waived if admitted) | $250 (waived if admitted) |
| Hospital | $100 | $100 |
Cost share amounts are waived when treatment is rendered at the Student Health Center.
Coinsurance
| Rate | |
|---|---|
| In-Network Physician/Facility | 20% of Allowable Charges (unless otherwise stated) |
| Out-of-Network Providers | 40% of UCR (Usual, Customary & Reasonable) |
Out-of-Pocket Maximum
| In-Network | Out-of-Network | |
|---|---|---|
| Out-of-Pocket Max | $6,000 per Insured Person | Unlimited per Insured Person |
Only coinsurance applies toward the Out-of-Pocket Maximum.
Area of Coverage
| Detail | |
|---|---|
| Area of Coverage | Worldwide, excluding Home Country |
| Maximum Limit | Unlimited |
| Pre-Existing Condition Limitation | Students: No limitation |
Prescription Drug Coverage
| Channel | Cost |
|---|---|
| EHIM In-Network Pharmacy / On-Campus Pharmacy — Tier 1 | $10 copayment per prescription |
| EHIM In-Network Pharmacy / On-Campus Pharmacy — Tier 2 | $20 copayment per prescription |
| EHIM In-Network Pharmacy / On-Campus Pharmacy — Tier 3 | $40 copayment per prescription |
| Out-of-Network | Not covered |
Pre-Attendance University Requirements & Wellness
(Cost share does not apply)
| Service | In-Network | Out-of-Network |
|---|---|---|
| Immunizations (must be obtained at the Student Health Center or an EHIM in-network pharmacy) | 100% of Allowable Charges | Not covered |
| TB Testing (Policyholder only; must be performed at an in-network free-standing lab or Student Health Center) | 100% of Allowable Charges | Not covered |
Wellness & Preventive Services
(Cost share does not apply)
| Service | In-Network | Out-of-Network |
|---|---|---|
| Adult Wellness Visit and Preventive Services | 100% including the Student Health Center | Not covered |
| Well Childcare Visits | 100% including the Student Health Center | Not covered |
Hospitalization Benefits
| Service | In-Network | Out-of-Network |
|---|---|---|
| Pre-admission Testing | 20% of Allowable Charges | 40% of UCR |
| Hospitalization | 20% of Allowable Charges + $100 copay/admission | 40% of UCR + $100 copay/admission |
| ICU / Telemetry / Surgical ICU / Medical ICU / Trauma / Pediatric ICU | 20% of Allowable Charges | 40% of UCR |
| Inpatient Treatment Mental Illness | 20% of Allowable Charges | 40% of UCR |
| Emergency Medical Services in ER (non-emergency use not covered) | 20% of Allowable Charges + $250 copay (waived if admitted) | 40% of Allowable Charges + $250 copay (waived if admitted) |
| Inpatient Physician, Osteopath & Specialist Services | 20% of Allowable Charges | 40% of UCR |
| Inpatient Ancillary Hospital Services | 20% of Allowable Charges | 40% of UCR |
| In-hospital Advanced Diagnostic Services | 20% of Allowable Charges | 40% of UCR |
| Routine X-Ray and Lab Tests | 20% of Allowable Charges | 40% of UCR |
| Inpatient Oncology Treatment | 20% of Allowable Charges | 40% of UCR |
| Inpatient Reconstructive Surgery | 20% of Allowable Charges | 40% of UCR |
| Inpatient Rehabilitation (max 30 days) | 20% of Allowable Charges | 40% of UCR |
| Inpatient Surgical Procedures | 20% of Allowable Charges | 40% of UCR |
| Inpatient Surgeon Fees, Assistant Surgeon Fees, Anesthesiologist | 20% of Allowable Charges | 40% of UCR |
| Emergency Ground Ambulance | 20% of Allowable Charges | 20% of Allowable Charges |
Outpatient Care Benefits
| Service | In-Network | Out-of-Network |
|---|---|---|
| Urgent Care Clinic / Facility | 20% of Allowable Charges + $50 copayment | 40% of UCR + $50 copayment |
| Outpatient Ambulatory Surgical Facility & Surgical Care¹ | 20% of Allowable Charges | 40% of UCR |
| Routine X-rays and Laboratory Tests¹ | 20% of Allowable Charges | 40% of UCR |
| Advanced Diagnostic & Interventional Radiology¹ | 20% of Allowable Charges | 40% of UCR |
| Outpatient Therapeutic Services | 20% of Allowable Charges + $30 copay per visit (max 12 visits) | 40% of UCR + $30 copay per visit (max 12 visits) |
| Outpatient Oncology Treatment | 20% of Allowable Charges | 40% of UCR |
| Outpatient Reconstructive Surgery | 20% of Allowable Charges | 40% of UCR |
| Diabetic Medical Supplies | 20% of Allowable Charges (max $7,500) | 40% of UCR (max $7,500) |
| Emergency Dental Treatment | 20% of Allowable Charges (max $250/tooth, up to $1,000) | 40% of UCR (max $250/tooth, up to $1,000) |
| Palliative Dental Treatment | 20% of Allowable Charges (max $600) | 40% of UCR (max $600) |
| Telemedicine Consultations and Visits | No copay — limited to 10 consults/visits | No copay — limited to 10 consults/visits |
| Primary Care Visit | 20% of Allowable Charges + $30 copay per visit | 40% of UCR + $30 copay per visit |
| Specialist Visit | 20% of Allowable Charges + $30 copay per visit | 40% of UCR + $30 copay per visit |
| Outpatient Mental Illness Visit | 20% of Allowable Charges + $30 copay per visit | 40% of UCR + $30 copay per visit |
| Alternative Medicine | 20% of Allowable Charges + $30 copay per visit (max $500) | 40% of UCR + $30 copay per visit (max $500) |
¹ When not performed in a physician's office or free-standing non-hospital facility, a Site of Service Differential cost applies. Cost share amounts are waived at the Student Health Center.
Other Services
| Service | In-Network | Out-of-Network |
|---|---|---|
| Recreational Activities / Amateur Sports Benefit | 20% of Allowable Charges | 40% of UCR |
| HIV/AIDS | 20% of Allowable Charges | 40% of UCR |
| Alcohol & Substance Abuse (rehabilitative only) | 20% of Allowable Charges + $30 copay (outpatient) | 40% of UCR + $30 copay (outpatient) |
| Home Health Care | 20% of Allowable Charges, immediately following hospital discharge of at least 3 days | 40% of UCR, immediately following hospital discharge of at least 3 days |
| Hospice or Palliative Care | 20% of Allowable Charges — Max 45 days (inpatient) / $5,000 (outpatient) | 40% of UCR — Max 45 days (inpatient) / $5,000 (outpatient) |
| Durable Medical Equipment | 20% of Allowable Charges | 40% of UCR |
Maternity Care & Birth Benefits
| Service | In-Network | Out-of-Network |
|---|---|---|
| Maternity Care (notify within 30 days of pregnancy confirmation) | 20% of Allowable Charges | 40% of UCR |
| Elective Medical Abortions | 20% of Allowable Charges (max $1,500) | 40% of UCR (max $1,500) |
| Worldwide Coverage (outside U.S., excludes Home Country and M1 visa holders) | 20% of UCR | — |
Accidental Death & Dismemberment
| Benefit | Amount |
|---|---|
| Accidental Death | Sum amount $30,000 |
| Dismemberment — loss of both hands, feet, or total sight | Sum amount $30,000 |
| Dismemberment — loss of one hand, one foot, or one eye | Sum amount $15,000 |
Evacuation & Repatriation
| Benefit | Amount |
|---|---|
| Emergency Medical Evacuation and Medical Repatriation | Combined Maximum Benefit $100,000 |
| Repatriation of Mortal Remains | Maximum Benefit $25,000 |
Certain benefits require pre-authorization. Refer to full Policy Terms and Conditions.
Cancellation & Refund Policy
- Waiver denied — must notify WellAway in writing within 15 days of denial, with proof. No refund if claims were filed during the policy period.
- School-approved leave of absence — must notify WellAway within 15 days, with proof of leave and return date. Refund is pro-rata minus a $50 early termination fee. No refund if claims were filed.
No refund applies for cancellations outside these two scenarios. A Force Majeure event does not automatically entitle a refund or extend the Policy Period.
Pre-Authorization Requirement
Certain procedures require Pre-Authorization by the Plan Administrator. Failure to pre-authorize results in a 30% penalty on the entire episode of care. If a service would not have been approved under Pre-Authorization, related claims are denied outright.
Notable Provisions
- Deductible ($1,250/$1,500)
- $100 hospital admission copay
- Out-of-pocket maximum ($6,000)
- No pre-existing condition limitation applies to students under this plan
- Minimum coverage period (full academic year, or 6 months for Spring/Summer-only purchase)