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 Spouse and Child | $100,000 | $100,000 |
| Per Illness/Injury Maximum | ||
| Student | $300,000 | $500,000 |
| Each eligible dependent Spouse and Child | $100,000 | $100,000 |
| Deductible | ||
| For Treatment received outside the US | $100 per Illness or Injury | $25 per Illness or Injury |
| For Treatment received inside the US | $100 per Illness or Injury | PPO: $25 per Illness or Injury Non-PPO: $50 per Illness or Injury |
| 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 | After the deductible, the plan pays 100% of eligible expenses up to Maximum Limit. | |
| For Treatment received within the US |
In the PPO Network or Student Health Center: After the deductible, the plan pays 100% of eligible expenses up to Maximum Limit Outside of the PPO Network:After the deductible, the plan pays 80% of eligible expenses up to $5,000, then 100% up to Maximum Limit |
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Inpatient or Outpatient Services
Subject to Deductible and Coinsurance unless otherwise noted. Eligible Medical Expenses are limited to Usual, Reasonable and Customary Limits per Period of Coverage unless stated as Maximum Limit |
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| Eligible Medical Expenses | Up to the maximum limit | |
| Physician Visits / Services |
Up to the maximum limit
1 visit per day Surgery is not subject to the maximum visit limit |
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| Hospital Emergency Room |
Up to the maximum limit. Illness: Subject to a $250 deductible for each ER visit for treatment that does not result in direct inpatient hospital admission. Injury: Not subject to emergency room deductible. |
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| Hospitalization / Room & Board | Average semi-private room rate up to the maximum limit. Includes nursing service, miscellaneous and Ancillary services. | |
| Intensive Care Unit (ICU) | Up to the maximum limit | |
| Outpatient Surgical / Hospital Facility | Up to the maximum limit | |
| Laboratory | Up to the maximum limit | |
| Radiology / X-ray | Up to the maximum limit | |
| Chemotherapy / Radiation Therapy | Up to the maximum limit | |
| Pre-admission Testing | Up to the maximum limit | |
| Surgery | Up to the maximum limit | |
| Reconstructive Surgery Surgery is incidental to and follows surgery that was covered under the plan | Up to the maximum limit | |
| Assistant Surgeon | 20% of the primary surgeon’s eligible fee | |
| Anesthesia | Up to the maximum limit | |
| Durable Medical Equipment | Up to the maximum limit Standard basic hospital bed and/or a standard basic wheelchair | |
| Chiropractic Care | Up to the maximum limit Medical order or treatment plan required | |
| Physical Therapy |
Up to the maximum limit
Medical order or treatment plan required 1 visit per day |
|
| Pre-Existing Conditions | Eligible expenses covered after 12 continuous months of coverage | Eligible expenses covered after 6 continuous months of coverage |
| Maternity Pre-natal care, delivery of a Newborn, and post-natal care of an Insured Person, including complications | No Coverage |
In the US: In-Network: 80% up to $5,000 Out-of-Network: 60% up to $5,000 Outside the US: 100% up to $5,000 |
| Routine Newborn Care | No Coverage | Included in Maternity Benefit during the first 31 days of life |
| Extended Care Facility | Up to the maximum limit Upon direct transfer from an acute care facility | |
| Home Nursing Care |
Up to the maximum limit
Provided by a Home Health Care Agency Upon direct transfer from an acute care facility |
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| COVID-19 Coverage | COVID-19/SARS-CoV-2 shall be considered the same as any other illness or injury, subject to all other terms and conditions. | |
| Prescription Medication |
Period of Coverage Limit: Primary Insured Person: $250,000 maximum Spouse and Child: $100,000 maximum Inpatient and Outpatient Surgery, Emergency Room, and Outpatient Office Visits Prescription Drugs and Medication: Up to the Period of Coverage Limit Retail Pharmacy Prescription Drugs and Medication: 50% coverage, 90 day dispensing maximum |
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| Mental or Nervous / Substance Abuse |
Inpatient: $10,000 maximum Outpatient: $50 limit per day, $500 maximum limit Not covered if incurred at Student Health Center |
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Emergency Services
NOT subject to Deductible and Coinsurance unless otherwise noted Eligible Medical Expenses are limited to Usual, Reasonable and Customary Limits per Period of Coverage unless stated as Maximum Limit |
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| Emergency Local Ambulance |
Per Injury: $350 Per Illness resulting in Inpatient Hospitalization: $350 |
Per Injury: $750 Per Illness resulting in Inpatient Hospitalization: $750 |
| Emergency Medical Evacuation | $500,000 lifetime maximum Must be approved in advance and coordinated by the Company | |
| Emergency Reunion |
$50,000 lifetime maximum 15 day maximum, $25 per day meal maximum Must be approved in advance by the Company |
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| Interfacility Ambulance Transfer |
Up to the maximum limit
Transfer must be a result of an Inpatient Hospital admission Services rendered in the United States |
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| Political Evacuation and Repatriation | $10,000 lifetime maximum Must be approved in advance by the Company | |
| Return of Mortal Remains |
$50,000 lifetime maximum Local Burial/Cremation: $5,000 maximum Must be approved in advance by the Company |
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Other Services
Subject to Deductible and Coinsurance unless otherwise noted Eligible Medical Expenses are limited to Usual, Reasonable and Customary Limits per Period of Coverage unless stated as Maximum Limit |
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| Accidental Death & Dismemberment Death must occur within 90 days of the accident |
Principal Sum:
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| Dental Treatment |
Treatment due to Unexpected Pain to Sound, Natural Teeth: $350 maximum
Non-Emergency Treatment due to an Accident: $500 maximum |
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| Traumatic Dental Injury | Up to the maximum limit. Additional treatment for the same injury rendered by a dental provider will be paid at 100%. Subject to deductible and coinsurance. | |
| Incidental Trip | Up to a cumulative 14 days Insured Person’s Country of Residence is not the United States | |
| Intercollegiate, Interscholastic, Intramural, and Club Sports | $5,000 per injury or illness | |
| Personal Liability Secondary to any other insurance |
$10,000 combined maximum limit. Injury to a third person: $100 per injury deductible. Damage to a third person’s property: $100 per damage deductible. No coverage for injury to a related third party or damage to related third person’s property. |
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| Terrorism | $50,000 Lifetime Maximum Not subject to deductible or coinsurance | |
Optional Riders
| Adventure Sports Rider (Available to insureds up to age 64) | |
|---|---|
| Certain activities designated as adventure sports can be covered up to the maximums listed below if the optional rider is purchased. Certain activities are never covered, regardless of whether the Adventure Sports Rider is purchased. For a list of activities considered to be adventure sports, please contact us. | |
| Age | Lifetime Maximum |
| 0–49 | $50,000 |
| 50–59 | $30,000 |
| 60–64 | $15,000 |
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.
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