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 |
|
| 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.
