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	$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
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	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: 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)	After deductible is met, the plan pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally.
Maternity
If incurred outside the US	Not eligible for coverage	After the deductible is met, the plan pays 100% of expenses up to $5,000
If incurred within the PPO network (in the US)	Not eligible for coverage	After the deductible is met, the plan pays 80% of expenses up to $5,000
If incurred outside of the PPO network (in the US)	Not eligible for coverage	After the deductible is met, the plan pays 60% of expenses up to $5,000
Routine Newborn Care	Not eligible for coverage	Included in Maternity Benefit during the first 31 days of life
Physical Therapy	After deductible is met, the plan pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally, limit one visit per day.
Mental & Nervous Treatment
Student Health Center	Not eligible for coverage
Outpatient Treatment	$50 per day; $500 Lifetime Maximum
Inpatient Treatment	After deductible is met, plan pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally up to $10,00 maximum limit.
Local Ambulance
Per Injury	$350	$750
Per Illness (only if admitted inpatient)	$350	$750
Prescription Drugs
Inpatient	After deductible is met, the plan pays 80% of expenses out-of-network (U.S.) or 100% in-network (U.S.) and internationally.
Outpatient	50% of actual charges
Dental
Injury due to covered accident	$500 period of coverage limit per injury
Sudden & Unexpected Pain	$350 period of coverage limit (to sound, natural teeth)
Additional Benefits
Intercollegiate, Interscholastic, Intramural or Club	$5,000 per Injury or Illness
Incidental Trip Coverage	Up to a cumulative 14 days (available for non-U.S. residents only)
Pre-existing Conditions	After 12 months of continuous coverage	After 6 months of continuous coverage
Terrorism Coverage	$50,000 Lifetime Maximum
Personal Liability	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
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.

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 here.
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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