PLAN INFORMATION & HIGHLIGHTS - Standard Short-Term Travel Plan | |||||
Plan Maximum | Choice of $50,000, $250,000 or $500,000 per illness or injury with a Lifetime Maximum of $5,000,000 | ||||
Coinsurance | No coinsurance | ||||
Deductible | $100 per Illness or Injury | ||||
Treatment Period | 60 days per chronic illness | ||||
MyIMGSM | 24 hour secure access from anywhere in the world to manage your account at anytime | ||||
International Emergency Care | A wide range of international emergency benefits available including emergency evacuation, emergency reunion, and return of mortal remains | ||||
Dependent Coverage | Coverage provided for dependents of faculty, scholars, students and exchange participants | ||||
Optional Add-on Plan | Additional coverage is available for high school sports, personal liability and legal assistance | ||||
Pre-existing Conditions | Available to U.S. and non-U.S. citizens - see Additional Benefits for more information |
MEDICAL BENEFITS | *Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment. |
Hospital Room and Board | Up to semi-private room rate |
Hospital Intensive Care | URC* |
Physical Therapy | URC* - 1 visit per day |
Physician Visit | URC* |
Student Health Center | $5 co-pay per visit |
Prescription Drugs | URC* |
Eligible Medical Expenses | URC* |
Emergency Room | URC* |
Emergency Room Illness with In-patient Admission | URC* |
Emergency Room Illness without In-patient Admission | Additional $250 deductible |
Dental |
INTERNATIONAL EMERGENCY CARE | When coordinated through the Plan Administrator |
Emergency Medical Evacuation | $50,000 Lifetime Maximum |
Emergency Reunion | $15,000 Lifetime Maximum |
Return of Mortal Remains | $25,000 |
Political Evacuation | Up to $10,000 |
ADDITIONAL BENEFITS | |
Accidental Death | $25,000 |
Dismemberment | $25,000 two limbs; $12,500 one limb |
Terrorism Coverage | Up to $50,000 Lifetime Maximum |
Sudden Recurrence of a Pre-existing Condition (U.S. citizens) | |
Pre-existing Conditions (For U.S. citizens, this benefit will begin when the Sudden Recurrence benefit is exhausted) | $500 per year; $50,000 lifetime maximum - after 12 months of continuous coverage |
Incidental Home Country Coverage | Up to a cumulative two weeks |
OPTIONAL ADD-ON PLAN | |
Baggage | |
Legal Assistance | |
Personal Liability | |
Damage to third person property | $500 limit after $100 deductible. Secondary to any other insurance in force |
Limited High School Sports Coverage | URC* |