Student Health Advantage Platinum

Comprehensive medical insurance for international students or scholars

Summary of Benefits

Platinum Plan Information
 
Maximum Limit

Student- $1,000,000
Dependent- $100,000

Maximum Limit per Illness or Injury

Student- $500,000
Dependent- $100,000

Deductible For treatment received outside of the U.S.: $25 per illness or injury
For treatment received within the U.S.: PPO provider: $25 per illness or injury; Non-PPO provider: $50 per illness or injury; Student health center: $5 copay per visit
Coinsurance

Outside of the U.S.: Company pays 100%
In PPO Network or Student Health Center within the U.S.: Company pays 100%             
Out of PPO Network if within the U.S.:
Company pays 80% of eligible expenses up to $5,000; then 100% thereafter

Hospital Room and Board Average semi-private room rate, including nursing service
Intensive Care After deductible is met, company pays 80% of expenses out-of-network (U.S) or 100% in-network (U.S.) and internationally
Maternity and Newborn Care $5,000 maximum limit. Benefit includes newborn routine care during the first 31 days of life.
After deductible is met, company pays 60% of eligible expenses out-of-network (U.S.), 80% in-network (U.S.) and 100% internationally
Emergency Room InjuryAfter deductible is met, company pays 80% of expenses out-of-network (U.S) or 100% in-network (U.S.) and internationally 
Emergency Room Illness resulting in hospitalization After deductible is met, company pays 80% of expenses out-of-network (U.S) or 100% in-network (U.S.) and internationally
Emergency Room Illness without Inpatient Admission After deductible is met, company pays 80% of expenses out-of-network (U.S) or 100% in-network (U.S.) and internationally; Subject to additional $250 deductible
Mental or Nervous / Substance Abuse

Outpatient- $50 per day; $500 maximum limit;
Inpatient: After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally up to $10,000 maximum limit;  
Student Health Center Treatment: $0

Prescription Drugs

Inpatient: After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally
Outpatient- 50% of actual charges
90 day dispensing maximum

Physical Therapy
(Medical order or treatment plan required)
After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally; limit one visit per day
Local Ambulance $750 per illness resulting in an inpatient hospitalization or injury
Dental Non-emergency treatment at a dental provider due to an accident - $500 period of coverage limit per injury; Unexpected pain to sound, natural teeth - $350 period of coverage limit
Eligible Medical Expenses After deductible is met, company pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally
Interfacility Ambulance Transfer
(For services rendered in the U.S.)
Company pays 100%. Transfer must be a result of an inpatient hospital admission
Emergency Medical Evacuation $500,000 maximum limit
Emergency Reunion $50,000 maximum limit
Return of Mortal Remains $50,000 maximum limit
Political Evacuation and Repatriation $10,000 maximum limit
Intercollegiate/Interscholastic/ Intramural or Club Sports $5,000 period of coverage limit per illness or injury
Incidental Trip Coverage Up to a cumulative 14 days (available for non-U.S. residents only)
Pre-existing Conditions Charges excluded until after six months of continuous coverage
Terrorism $50,000 maximum limit
AD&D

Student- $25,000 principal sum

Spouse- $10,000 principal sum

Dependent child- $5,000 principal sum

Accidental dismemberment percentage of principal sum

Personal Liability
(Secondary to any other insurance)
$10,000 combined maximum limit
Injury to third person: subject to a $100 per injury deductible
Damage to third person's property: subject to a $100 per damage deductible

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, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snorkeling, snowmobiling, spelunking, surfing, trekking, whitewater rafting (to Class V), and 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. Please see exclusion 8 in the exclusions page. 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.