All amounts listed are in U.S. dollars. Click the gray titles to see further information.
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PLAN INFORMATION & HIGHLIGHTS
| Lifetime Maximum |
|
 |
| Student |
$500,000 |
| Dependent |
$50,000 |
|
| Per Illness/Injury Maximum |
|
|
| Student |
$300,000 |
| Dependent |
$50,000 |
| Deductible |
|
|
| $100 per Illness/Injury |
|
|
| $50 per Illness/Injury if Treatment received in Student Health Center |
| Coinsurance |
100% |
|
| For treatment received outside the U.S. & Canada: No coinsurance |
| For treatment received within the U.S. & Canada: |
| In the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Policy Maximum |
| Outside the PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Policy Maximum |
| MEDICAL BENEFITS |
USUAL, REASONABLE AND CUSTOMARY CHARGES, SUBJECT TO DEDUCTIBLE AND COINSURANCE |
| Hospital Room and Board |
Up to semi-private room rate |
| Maternity |
URC following 10 month waiting period up to policy maximum |
|
Subject to a waiting period for the first 10 months of coverage, the plan provides coverage for maternity the same as any illness. Routine nursery care of newborns is also subject to the maximum limit.
| Routine Nursery Care |
$750 maximum per certificate period |
| Emergency Room |
|
|
| Injury |
URC* |
| Illness resulting in hospitalization |
URC* |
| No hospitalization |
Subject to additional $250 deductible |
| Mental Health (Treatment at Student Health Center is not eligible) |
URC* |
| Outpatient |
$50 per day
$500 lifetime maximum |
| Inpatient |
URC to $10,000 lifetime maximum |
| Inpatient |
URC* |
| Outpatient |
50% of actual charges |
| Physical Therapy |
URC* - limit once per day |
| Per Injury |
Up to $350 |
| Per Illness only if admitted Inpatient |
Up to $350 |
| Dental |
|
|
| Injury due to covered Accident |
$500 |
| Sudden & Unexpected Pain |
$350 |
| All Other Eligible Medical Expenses |
URC* |
| INTERNATIONAL EMERGENCY CARE |
(WHEN COORDINATED THROUGH THE PLAN ADMINISTRATOR) |
| Emergency Medical Evacuation |
$500,000 lifetime maximum (independent of Policy Maximum) |
|
Student Health Advantage includes coverage for emergency medical evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to $500,000 lifetime maximum (independent of Policy Maximum).
| Emergency Reunion |
$50,000 maximum |
|
Student Health Advantage provides emergency reunion coverage for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured. The coverage also includes a round trip air ticket for a relative if the member is hospitalized for seven days or longer.
| Return of Mortal Remains |
$50,000 |
|
If a covered illness/injury results in death, expenses for repatriation of bodily remains or ashes to the home country will be covered.
| Political Evacuation |
Up to $10,000 |
|
If the United States Department of State, Bureau of Consular Affairs issues a mandatory evacuation order of the host country that becomes effective on or after the insured person's date of arrival in the host country, the Company will pay up to $10,000 lifetime maximum for transportation to the nearest place of safety or for repatriation to the insured person's home country or country of residence provided that:
- 1. The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular Affairs issues the evacuation order;
- 2. Political Evacuation and Repatriation is approved and coordinated by the Company.
| Intercollegiate/Interscholastic/ Intramural or Club Sports |
$5,000 per Injury/Illness Medical Expenses only |
| Pre-existing Conditions |
After 12 months of continuous coverage |
| Terrorism Coverage |
Up to $50,000 Lifetime Maximum |
|
Student Health Advantage provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.
Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the six months prior to the insured person's date of arrival.
This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.
| AD&D |
|
| Student |
$25,000 |
| Dependent Spouse |
$10,000 |
| Dependent Child |
$5,000 |
| Dismemberment Levels |
Scheduled |
* This Web page contains only a consolidated and summary description of all current benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.