Student Health Advantage

Comprehensive medical insurance for international students or scholars

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Summary of Benefits

All amounts shown are in U.S. dollars.

Coverage Limit / Maximum Amount for Eligible Medical Expenses
 
BenefitsIn-NetworkOut-of-NetworkInternational
Maximum LimitStudent: $500,000 Dependent: $100,000Student: $500,000 Dependent: $100,000Student: $500,000 Dependent: $100,000
Per Illness or Injury limit Student: $300,000 Dependent: $100,000Student: $300,000 Dependent: $100,000Student: $300,000 Dependent: $100,000
Deductible
  • Per Illness or Injury
$250$250$250
Coinsurance for Eligible Medical Expenses
 
BenefitsIn-NetworkOut-of-NetworkInternational
Coinsurance
  • In addition to Deductible
Plan pays 90%
Insured pays 10%		Plan pays 80%
Insured pays 20%		Plan pays 100%
Insured pays 0%
Out of Pocket Maximum$1,000Up to the Maximum Limit$0
Precertification
 
BenefitsIn-NetworkOut-of-NetworkInternational
Interfacility Ambulance Transfer, Emergency Medical EvacuationNo coverage if Pre-certification requirements are not metNo coverage if Pre-certification requirements are not metNo coverage if Pre-certification requirements are not met
All other Treatments & supplies50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met
Pre-existing Conditions
 
Charges resulting directly or indirectly from or relating to any Pre-existing Condition that existed within 36 months prior to the Effective Date are excluded until the Insured Person has maintained 12 months of continuous coverage under this insurance.
Student Health Center
 
BenefitsIn-NetworkOut-of-NetworkInternational
Copayment per visit
  • Not subject to the per Illness or Injury Deductible
$5$5$5
CoinsurancePlan pays 100%
Insured pays 0%		Plan pays 100%
Insured pays 0%		Plan pays 100%
Insured pays 0%
Inpatient/Outpatient Benefits
 
BenefitsIn-NetworkOut-of-NetworkInternational
Eligible Medical Expenses90%80%100%
Physician Visits/Services
  • Maximum Visits per day: 1
  • Surgery is not subject to the Maximum visit limit
90%80%100%
Hospital Emergency Room
  • Injury: Not subject to Emergency Room Deductible
  • Illness: Subject to a $250 Deductible for each Emergency Room visit for Treatment that does not result in a direct Hospital admission.
90%80%100%
Teledoc Consultation (Groups only)
  • Not subject to Deductible and Coinsurance
  • Mental or Nervous Disorders are not covered
  • Coverage for a Teladoc Consultation is not a determination that any specific condition discussed, raised or identified during such consultation is covered under this insurance. The Company reserves the right to decline future claims relating to or arising from any condition discussed, raised or identified during a Teladoc Consultation where the Illness or Injury is directly or indirectly related to any Pre-existing Condition or is otherwise excluded under this Certificate of Insurance
Hospitalization / Room & Board
  • Average semi-private room rate
  • Includes nursing, miscellaneous and Ancillary Services
90%80%100%
Intensive Care90%80%100%
Outpatient Surgical / Hospital Facility90%80%100%
Laboratory90%80%100%
Radiology / X-ray90%80%100%
Chemotherapy / Radiation Therapy90%80%100%
Pre-admission Testing90%80%100%
Surgery90%80%100%
Reconstructive Surgery
  • Surgery is incidental to and follows Surgery that was covered under the plan
90%80%100%
Assistant Surgeon
  • 20% of the primary surgeon’s eligible fee
90%80%100%
Anesthesia90%80%100%
Durable Medical Equipment90%80%100%
Chiropractic Care
  • Medical order or Treatment plan required
90%80%100%
Physical Therapy
  • Maximum Visits per day: 1
  • Medical order or Treatment plan required
90%80%100%
Extended Care Facility
  • Upon direct transfer from an acute care Hospital
90%80%100%
Home Nursing Care
  • Provided by a Home Health Care Agency
  • Upon direct transfer from an acute care Hospital
90%80%100%
Prescription Drugs and Medication - The following Prescription Drugs and Medication Period of Coverage limit accumulates toward the Maximum Limit
 
BenefitsIn-NetworkOut-of-NetworkInternational
Period of Coverage limit
  • Subject to the Coinsurance amounts listed below
  • Student: $250,000 per person
  • Dependents: Up to the Maximum Limit ($100,000)
  • Student: $250,000 per person
  • Dependents: Up to the Maximum Limit ($100,000)
  • Student: $250,000 per person
  • Dependents: Up to the Maximum Limit ($100,000)
Inpatient and Outpatient Surgery Prescription Drugs and Medication90%80%100%
Emergency Room and Outpatient Office Visits
Prescription Drugs and Medication		90%80%100%
Retail Pharmacy Prescripton Drugs and Medication
  • Dispensing maximum for Retail Pharmacy: 90 days per prescription
N/A50%50%
Mental or Nervous / Substance Abuse
 
BenefitsIn-NetworkOut-of-NetworkInternational
Inpatient Mental or Nervous / Substance Abuse
  • Maximum Limit: $10,000
  • Not covered if incurred at the Student Health Center
90%80%100%
Outpatient Mental or Nervous / Substance Abuse
  • Maximum Limit per day: $50
  • Maximum Limit: $500
  • Not covered if incurred at the Student Health Center
90%80%100%
Emergency Services
 
BenefitsIn-NetworkOut-of-NetworkInternational
Emergency Local Ambulance
  • Period of Coverage Limit per Injury $350
  • Period of Coverage Limit per Illness $350 (resulting in an Inpatient Hospitalization)
100%100%100%
Emergency Medical Evacuation
  • Maximum Limit: $500,000
  • Must be approved in advance and coordinated by the Company
100%100%100%
Emergency Reunion
  • Maximum Limit: $50,000
  • Maximum Days: 15
  • Meal Maximum per day: $25
  • Reasonable and necessary travel costs and accommodations
  • Must be approved in advance by the Company
100%100%100%
Interfacility Ambulance Transfer
  • Up to the per Injury or Illness limit
  • Services rendered in the United States
  • Transfer must be a result of an Inpatient Hospital admission
100%100%N/A
Political Evacuation and Repatriation
  • Maximum Limit: $10,000
  • Must be approved in advance by the Company
100%100%100%
Repatriation for Medical Treatment
  • Maximum Benefit: $100,000
  • Approved in advance and coordinated by the Company
  • Refer to the REPATRIATION FOR MEDICAL TREATMENT provision for further details
100%100%100%
Return of Mortal Remains
  • Maximum Limit: $50,000
  • Local Burial / Cremation at place of death
  • Maximum Limit: $5,000
  • Return of Insured Person’s Mortal Remains to Country of Residence
  • Must be approved in advance by the Company
100%100%100%
Other Services
 
BenefitsIn-NetworkOut-of-NetworkInternational
Terrorism
  • ƒ Not subject to Deductible and Coinsurance
  • Maximum Limit: $50,000
100%100%100%
Dental Treatment
  • Period of Coverage Limit: $350
  • (Treatment due to Unexpected pain to sound, natural teeth)
  • Period of Coverage Limit per Injury: $500
(Non-emergency Treatment at a Dental Provider due to an Accident) 		N/A90%100%
Traumatic Dental Injury
  • Treatment at a Hospital Facility due to an Accident
  • Additional Treatment for the same Injury rendered by a Dental Provider will be paid at 100%
90%80%100%
Intercollegiate, Interscholastic, Intramural, or Club Sports
  • Period of Coverage Limit per illness or injury: $5,000
90%80%100%
Accidental Death & Dismemberment
  • Not subject to Deductible and Coinsurance
  • Death must occur within 90 days of the Accident
Accidental Death: 100% of Principal Sum
Student: $25,000
Spouse: $10,000
Child: $5,000
Accidental Dismemberment:
LossPercent of Principal Sum
Sight of 1 eye50%
1 hand or 1 foot50%
1 hand and loss of sight of 1 eye100%
1 foot and loss of sight of 1 eye100%
1 hand and 1 foot100%
Both hands or both feet100%
Sight of both eyes100%
Incidental Trip
  • Maximum days: 14
  • Country of Residence is outside the United States
  • Refer to the INCIDENTAL TRIP provision for further details
90%80%100%
Personal Liability
  • Secondary to any other insurance
  • No coverage for Injury to a related Third Party or damage to related Third Person’s property
  • Refer to the PERSONAL LIABILITY provision for further details and requirements
Combined Maximum Limit: $10,000

Injury to Third Person:
Per Injury Deductible: $100

Damage to Third Person’s property: Per damage Deductible: $100 		Combined Maximum Limit: $10,000

Injury to Third Person:
Per Injury Deductible: $100

Damage to Third Person’s property: Per damage Deductible: $100 		Combined Maximum Limit: $10,000

Injury to Third Person:
Per Injury Deductible: $100

Damage to Third Person’s property: Per damage Deductible: $100

Adventure Sports Rider

The Adventure Sports Rider is available for those up to the age of 65. The following activities are covered to the lifetime maximum amounts listed below as long as they are engaged solely for leisure, recreation, or entertainment purposes: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hot air ballooning, jungle zip lining, parachuting, paragliding, parascending, rappelling, skydiving; spelunking, whitewater kayaking, wildlife safaris, and windsurfing.

All such activities must be carried out in strict accordance with the rules, regulations, and guidelines of the applicable Governing Body or Authority of each such activity. Certain sports activities are never covered, regardless of whether or not you purchase the Adventure Sports Rider. A complete list of these sports activities can be found in the exclusions section of the Certificate of Insurance. Please note this is only a summary of Adventure Sports and exclusions. For additional information, please refer to the Certificate of Insurance.

Age Maximum Limit
Through age 49 $50,000
50-59 $30,000
60-64 $15,000

Disclaimer

This invitation to inquire allows eligible applicants an opportunity to inquire further about the insurance offered and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract. The contract does contain a pre-existing condition exclusion and does not cover losses or expenses related to a pre-existing condition.

Please note that this insurance is not subject to, and does not provide benefits required by, ACA. On January 1, 2014, ACA requires U.S. citizens, U.S. nationals and resident-aliens to obtain ACA compliant insurance coverage unless they are exempt from ACA (international students on F, J, M and Q visas (and certain family members of students) are not subject to the individual mandate for their first 5 years in the U.S. All other J categories - teacher, trainee, work and travel, au pair, high school, etc. - are not subject to the individual mandate for 2 years out of the past six). Penalties may be imposed on persons who are required to maintain ACA compliant coverage but do not do so. Eligibility to purchase or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including ACA. Please note that it is solely your responsibility to determine if ACA is applicable to you and the Company and IMG shall have no liability whatsoever, including for any penalties that you may incur, for your failure to obtain required ACA compliant coverage.

 

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