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Student Health Advantage | Benefits

The Student Health advantage plan is available in two levels: Standard and Platinum. Please see the list of benefits below to compare the benefits specific to each plan level.

Standard Platinum
Lifetime Maximum
Student $500,000 $1,000,000
Dependent $100,000 $100,000
Per Illness/Injury Maximum
Student $300,000 $500,000
Each eligible dependent $100,000 $100,000
Deductible
For Treatment received outside the US & Canada $100 per Illness or Injury $25 per Illness or Injury
For Treatment received inside the US & Canada $100 per Illness or Injury PPO: $25 per Illness or Injury
Non-PPO: $50 per Illness or Injury
Emergency Room
An additional Deductible of $250 will be applied for each Emergency Room visit for Treatment of an Illness which does not result in a direct hospital admission.
Student Health Center
$5 co-pay per visit if Treatment received in Student Health Center (not subject to deductible)
Coinsurance
For Treatment received outside the US & Canada The plan pays 100% of eligible expenses up to Maximum Limit
For Treatment received within the US & Canada In the PPO Network or Student Health Center:

The plan pays 100% of eligible expenses up to Maximum Limit

Outside of the PPO Network:

The plan pays 80% of eligible expenses up to $5,000, then 100% up to Maximum Limit

Provider Network

Medical Benefits
Hospital Room & Board Average semi-private room rate
Intensive Care Unit (ICU) URC
Maternity
If incurred Outside of US/Canada Not eligible for coverage 100%
If incurred within the PPO Network Not eligible for coverage 80%
If incurred outside the PPO Network Not eligible for coverage 60%
Routine Newborn Care Not eligible for coverage $750 maximum per period of coverage
Physical Therapy
URC - limit once per day
Mental & Nervous Treatment
Student Health Center Not eligible for coverage
Outpatient Treatment $50 per day; $500 Lifetime Maximum
Inpatient Treatment $10,000 Lifetime Maximum
Local Ambulance
Per Injury $350 $750
Per Illness (only if admitted inpatient) $350 $750
Prescription Drugs
Inpatient URC
Outpatient 50% of actual charges
Dental
Injury due to covered Accident $500
Sudden & Unexpected Pain $350
Benefit Period
60 days
Additional Benefits
Intercollegiate, Interscholastic, Intramural or Club $5,000 per Injury or Illness
Incidental Home Country Coverage Up to 14 day
Pre-existing Conditions After 12 months of continuous coverage After 6 months of continuous coverage
Terrorism Coverage $50,000 Lifetime Maximum
Accidental Death & Dismemberment (AD&D)
Eligible Participant $25,000
Spouse $10,000
Dependent Child $5,000
Dismemberment Levels Scheduled
International Emergency Care
Medical Evacuation $500,000 Lifetime Maximum
Emergency Reunion $50,000 Lifetime Maximum
Return of Mortal Remains $50,000 Lifetime Maximum
Political Evacuation And Repatriation $10,000 Lifetime Maximum

* All coverages, benefits and premium amounts shown are in U.S. dollars.
* URC: Usual, Reasonable, Customary

Optional Riders

Adventure Sports Rider
(Available to insureds up to age 65)
Age Lifetime Maximum
0-49 $50,000
50-59 $30,000
60-64 $15,000
Six Month Pre-existing Condition Rider (available only if the insured's destination is Florida, Hawaii, Idaho, or Massachusetts)

This website contains only a consolidated and summary description of all current Student Health Advantage 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 application and/or brochure has expired, is modified, or is replaced with a newer version. Please view the plan certificate ( Standard | Platinum ) for the full benefits and limitations of the plan.


student health advantage