All amounts shown are in U.S. dollars. Click the orange headers for further information.
| Lifetime Maximum |
| Student |
$500,000 |
| Dependent |
$50,000 |
|
| Per Illness/Injury Maximum |
| Student |
$300,000 |
| Each eligible dependent |
$50,000 |
|
| Deductible |
$100 per Illness/Injury
$5 co-pay per visit if Treatment received in Student Health Center |
| Coinsurance |
|
Charges incurred outside the U.S.: No coinsurance
Charges incurred within the U.S.:
In the PPO Network or Student Health Center: No coinsurance
Outside the PPO Network: 80% of the first $5,000 of eligible charges, then 100% thereafter |
| Hospital Room & Board |
Average semi-private room |
| Intensive Care |
URC |
| Maternity |
URC |
| The plan provides coverage for maternity the same as any illness. Conception must occur after the effective date. Routine nursery care of newborns is also subject to the Maximum Limit. |
| Routine Nursery Care |
$750 maximum per period of coverage |
| Emergency Room |
|
| Injury |
URC |
| Illness resulting in hospitalization |
URC |
| No hospitalization |
Subject to additional $250 deductible |
|
| Mental Health (Includes alcohol and substance abuse. Treatment at Student Health Center is not eligible) |
| Out-patient |
$50 per day; $500 lifetime maximum |
| In-patient |
URC to $10,000 lifetime maximum |
|
| Prescription Drugs |
|
| In-patient |
URC |
| Out-patient |
50% of actual charges |
|
| Physical Therapy |
URC - limit once per day |
| Local Ambulance |
| Per Injury |
Up to $350 |
| Per Illness only if admitted In-patient |
Up to $350 |
|
| Dental |
|
| Injury due to covered Accident |
$500 |
| Sudden & Unexpected Pain |
$350 |
|
| All Other Eligible Medical Expenses |
URC |
| Emergency Medical Evacuation |
$500,000 lifetime maximum (independent of Maximum Limit) |
| 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 Maximum Limit). |
| 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 maximum |
| 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 lifetime maximum |
If the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person’s Home Country, orders the evacuation of all non-emergency government personnel from the Host Country, due to political unrest, that becomes effective on or after the Insured Person’s date of arrival in the Host Country, the Company will pay up to a $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:
- The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person’s Home Country, issuance of the evacuation order; and
- The evacuation order pertains to persons from the same Home Country as the Insured Person; and
- 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 |
| Incidental Home Country Coverage |
Up to a cumulative two weeks |
During the Period of Coverage an insured person may return to their home country for incidental visits up to a cumulative two weeks total, subject to:
- The insured person must have left their home country,
- The total Period of Coverage must be for a minimum of 30 days, and
- The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling.
|
| 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 |
|
| Benefit Period |
60 Days |
* 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.
