Student Health Advantage - Excluding USA

Plan Detail

Plan Administrator:  International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius International

  • PPO Network(Within USA or Canada): 80% of Eligible Expenses after the Deductible up to $5,000, then 100% up to policy max.
  • Eligibility:  A Full time Student & Non US Citizen  Age 14-64 travelling USA to study
  • Coverage length: Min 3months to 12months
  • Provider Network: PPO Providers are contracted separately through First Health Group Corp
  • Renew Online: Provided there is no break in coverage, the plan may be renewed for up to five years
  • Cancel: Before effective date full refund and after policy effective date unused portion of premium minus $50 cancellation fees.
  • ID card & Visa Letter comes in email instantly.

Benefits


Maximum Limit Student: $500,000; Dependent: $100,000
Maximum Limit per Illness or Injury Student: $300,000; Dependent: $100,000
Deductible $100 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
Emergency Room Injury 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 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 $350 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 12 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