Plan Administrator: International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius Group, Sirius Specialty Insurance Corporation
| Age and Policy Maximum |
Age 0-64 $100,000 |
| Doctor Visit | Maximum Visits per Day: 1 • Surgery is not subject to the maximum visit limit |
| Surgical Treatment | Up to the overall maximum limit |
| Hospital Room and Board | Average semi-private room rate • Includes nursing, miscellaneous and Ancillary Services |
| Ambulance | Period of Coverage Limit per Injury: $750 • Period of Coverage Limit per Illness $750 (resulting in an Inpatient Hospitalization) |
| Prescription | Inpatient:100% Outpatient:N/A |
Complete details are given in certificate of insurance.
Complete details are given in certificate of insurance.
Pre-Existing Condition Rider(Platinum Plan Only):
Charges excluded until after 6 months of continuous coverage
The Maternity & Pre-Existing Condition Rider is available for eligible participants. Under this rider, eligible medical expenses for pre-natal care, delivery, post-natal care, and care of newborns can be covered after the insured has maintained coverage continuously for 10 months and the pregnancy is a result of natural insemination. Eligible medical expenses relating to a pre-existing condition can be covered after the insured has maintained coverage continuously for 6 months.
With the Student Health Advantage Plan you may seek treatment with the hospital or doctor of your choice. When seeking treatment in the U.S., you can reduce your out-of-pocket costs by using the independent Preferred Provider Organization (PPO), a separately organized network of hundreds of thousands of established, highly qualified health care physicians and many well-recognized hospitals in the U.S. contracted by IMG. You can quickly search the network through MyIMG. Additionally, to help you locate health care providers outside the U.S., IMG provides its online International Provider AccessSM(IPA), a database of over 17,000 providers.Our goal is to provide quality medical coverage wherever you may be. The PPO and our IPA enable us to do just that, and our online directories put the information at your fingertips - anytime, anywhere.
If the plan is purchased for a minimum of three months, coverage may be extended up to 12 months from the initial effective date. Provided there is no break in coverage, the plan may be renewed for up to five years.
I(we) understand and agree that subject to your acceptance of your application and payment of the total amount due coverage will begin at 12:01 am. On the day after this completed application is received and approved. I(we) understand that if the premium is return/unpaid for any reason, coverage becomes null/void. I(we) acknowledge and understand that if not completely satisfied after receiving the contract. The Insurance person may request cancellation of the insurance retroactive to the effective date by sending a return request to the company within the review period outlined in the written request to the company within reviewed period outlined of the insurance contract, and thereby receive a refund of premium paid.
Each proposed hospital admission, in-patient or out-patient surgery, and other procedures as noted in the Certificate Wording must be Precertified for medical necessity, which means the insured person or their attending physician must call the number listed on the IMG Identification Card prior to admittance to a hospital or performance of a surgery. In case of an Emergency Admission, the Precertification call must be made within 48 hours of the admission, or as soon as reasonably possible. If a hospital admission or a surgery is not Precertified, eligible claims and expenses will be reduced by 50%. It is important to note that Precertification is only a determination of medical necessity, not an assurance of coverage, verification of benefits or a guarantee of payment. All medical expenses must meet usual, reasonable, customary, and eligible payment guidelines. Please refer to the Certificate Wording for full details of the Precertification requirements.
All benefits payable under Student Health Advantage are subject to the provisions described in this brochure and as contained in the Certificate Wording and certificate of coverage. To make claim processing efficient, claims may be paid in two ways: