If an Insured Person is not eligible, this Certificate is void ab initio and all premium paid will be refunded. In order to be eligible and qualified for coverage under this insurance, a person must:

  1. be a Full-Time Student or Scholar, the Spouse of the Full-Time Student or Scholar, or a Dependent traveling with the Full-Time Student or Scholar, and residing outside their Home Country for the purpose of pursing international educational activities including, but not limited to college course work, research, or teaching for a temporary period of time; and
  2. at the time of the Effective Date, be physically residing in Host Country with the intent to reside there for at least thirty days; and
  3. complete and sign an Application as the Insured Person (or be listed thereon by proxy as an applicant and proposed Insured Person), and/or as the Insured Person’s spouse and/or Child; and
  4. pay the required Premium on or before the Effective Date of Coverage; and
  5. receive written acceptance of his/her Application or renewal from the Company; and
  6. be at least thirty one (31) days old but not yet sixty-five (65) years old; and
  7. not be Hospitalized or Disabled on the Initial Effective Date; and
  8. not be HIV+ on the Initial Effective Date.

Subject to the Terms of this insurance and the insurance plan shown in the Declaration, the following insurance plan is available to the Insured Person while outside his/her Home Country and offer the following benefits and coverage arising out of Injury or Illness incurred while in the Host Country and the insurance pl an shown in the Declaration is in effect:

Coverage Limit / Maximum Amount for Eligible Medical Expenses
Period of Coverage Maximum Limit: 365 days
Period of Coverage Maximum Limit Insured Person: $1,000,000 / Spouse and Dependent: $100,000
Per Illness or Injury Maximum Limit Insured Person: $500,000 / Spouse and Dependent: $100,000
Minimum Treatment Period 60 days
Benefit Plan Features
Benefit Levels

United StatesIn-Network

United StatesOut of Network

InternationalInternational

Deductible / Coinsurance for Eligible Medical Expenses
Deductible Per Ill ness or Injury

$25

$50

$25

CoinsuranceMaximum Out of Pocket: $1,000

Plan pays 100% Insured pays 0%

Plan pays 80% Insured pays 20%

Plan pays 100% Insured pays 0%

Student Health Center
Visit Copay Not subject to Deductible $5
Coinsurance 100%
Precertification
Benefit U.S. In-Network Benefit U.S. Out-of-Network International

Refer to Pre-certification Provisions/Requirements for a complete list of services that require pre-certification.

Pre-certification Requirements not met will result in a 50% reduction in Eligible Medical Benefits.

Maternity and Newborn care not pre-certified within sixty (60) days of delivery will result in a 50% penalty.

Inpatient or Outpatient Services Subject to Deductible unless otherwise noted Maximum Limits per Period of Coverage or if Indicated, Per Lifetime

Eligible Medical Expenses 100% 80% 100%
Physician Visits Visit Limit per Day: 1(unless for Surgery) 100% 80% 100%

Hospital Emergency Room

Emergency Room Deductible: $250

applied for each Emergency Room

visit for Treatment of an Illness which

does not result in a direct Hospital admission

100% 80% 100%
Intensive Care Unit 100% 80% 100%
Outpatient Surgical / Hospital Facility 100% 80% 100%
Laboratory 100% 80% 100%
X-rays / MRI and CAT Scans 100% 80% 100%
Maternity 80% 80% 100%
Routine Newborn Care Maximum Limit: $750 100% 80% 100%
Surgery 100% 80% 100%

Reconstructive Surgery

Medically Necessary

Surgery directly related to and follows

a Surgery which was covered under

this insurance

100% 80% 100%

Assistant Surgeon

The Plan pays 20% of the Usual,

Reasonable and Customary charge

of the primary surgeon

100% 80% 100%

Physical Therapy

Outpatient Visit Limit per Day: 1

100% 80% 100%

Prescriptions Subject to Deductible unless otherwise noted Maximum Limits per Period of Coverage or if Indicated, Per Lifetime

Benefit U.S. In-Network Benefit U.S. Out-of-Network International
Inpatient 100% 80% 100%
Outpatient 50% 50% 50%

Mental or Nervous Subject to Deductible unless otherwise noted Maximum Limits per Period of Coverage or if Indicated, Per Lifetime

Inpatient Mental or Nervous /

Substance Abuse

Lifetime Maximum: $10,000

Not covered if incurred at the Student

Health Center

100% 80% 100%

Outpatient Mental or Nervous /

Substance Abuse

Dollar Limit Maximum per Day: $50

Lifetime Maximum: $500

Not covered if incurred at the Student

Health Center

100% 80% 100%

Emergency Services Subject to Deductible unless otherwise noted Maximum Limits per Period of Coverage or If Indicated, Per Lifetime

Emergency Local Ambulance

Maximum Limit per Injury: $750

Maximum Limit per Illness: $750

(resulting in a Hospital confinement

as an Inpatient)

100% 100% 100%

Emergency Medical Evacuation

Not subject to Deductible

Lifetime Maximum Limit: $500,000

Approved in advance and

Coordinated by the Company

100% 100% 100%

Return of Mortal Remains Not

Subject to Deductible

Maximum Limit: $50,000

Local Burial / Cremation

Maximum Limit: $5,000

Return of Insured Person’s Mortal

Remains to Country of Residence.

Approved in advance and

Coordinated by the Company

100% 100% 100%

Emergency Services Subject to Deductible unless otherwise noted Maximum Limits per Period of Coverage or If Indicated, Per Lifetime

Benefit U.S. In-Network Benefit U.S. Out-of-Network International

Emergency Reunion

Not Subject to Deductible

Maximum Limit: $50,000

Maximum Days: 15 days

Meal Maximum: $25 per day

Reasonable and necessary travel

costs and accommodations

Approved in advance and

Coordinated by the Company

100% 100% 100%

Political Evacuation And Repatriation

Not Subject to Deductible

Lifetime Maximum: $10,000

Approved in advance and

Coordinated by the Company

100% 100% 100%

Other Services Subject to Deductible unless otherwise noted. Maximum Limits per Period of Coverage or if Indicated, Per Lifetime

Emergency Dental

Maximum Limit: $350

(relief of sudden and unexpected pain

to sound, natural teeth, including, but

not limited to fillings)

Accident Maximum Limit per Injury:

$500 (including jaw fracture)

100% 80% 100%

Terrorism

Lifetime Maximum: $50,000

100% 100% 100%

collegiate / Interscholastic /

Intramural or Club Sports Coverage

Maximum Limit per Illness/Injury: $5,000

100% 80% 100%

Accidental Death & Dismemberment

Not Subject to Deductible

Accidental Death Principal Sum

Insured: $25,000

Spouse: $10,000

Dependent Child: $5,000

Dismemberment: Review the schedule in the ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT provision

Incidental Trip: Up to 14 days 100% 80% 100%

Exclusions

Except as expressly provided for in the BENEFIT SUMMARY, all Charges, costs, expenses and/or claims incurred by the Insured Person, and any claim for death or dismemberment benefits, and directly or indirectly relating to or arising or resulting from or in connection with any of the following acts, omissions, events, conditions, Charges, consequences, claims, Treatment (including diagnoses, consultations, tests, examinations and evaluations related thereto), services and/or supplies are expressly excluded from coverage under this insurance, and the Company shall provide no benefits or reimbursements and shall have no liability or obligation for any coverage thereof or therefor:

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.

The Company, through the Plan Administrator, endeavors to maintain a contractual arrangement with one or more independent Preferred Provider Organizations (PPO) that has established and maintains a network of U.S.-based Physicians, Hospitals and other healthcare and health service providers who are contracted separately and directly with the PPO and who may provide re-pricings, discounts or reduced charges for Treatment or supplies provided to the Insured Person. Neither the Company nor the Plan Administrator has any authority or control over the operations or business of the PPO, or over the operations or business of any provider within the independent PPO network. Neither the PPO nor provider within the PPO network nor any of their respective agents, employees or representatives has or shall have any power or authority whatsoever to act for or on behalf of the Company or the Plan Administrator in any respect, including without limitation no power or authority to: (i) approve Applications or enrollments for initial, renewal or reinstated coverage under this insurance plan or to accept Premium payments, (ii) accept risks for or on behalf of the Company, (iii) act for, speak for, or bind the Company or the Plan Administrator in any way, (iv) waive, alter or amend any of the Terms of the Master Policy or this Certificate or waive, release, compromise or settle any of the Company’s rights, remedies, or interests thereunder or hereunder, or (v) determine Pre-certification, eligibility for coverage, verification of benefits, or make any coverage, benefit or claim adjudications or decisions of any kind. It is not a requirement of this insurance that the Insured Person seek Treatment or supplies exclusively from a provider within the independent PPO network. However, the Insured Person’s use or non-use of the PPO network may affect the scope and extent of benefits available under this insurance, including without limitation any applicable Deductible, Coinsurance and benefit reduction, as set forth above. An Insured Person may contact the Company through the Plan Administrator and request a PPO Directory for the area where the Insured Person will be receiving consultation or Treatment (therein listing the Physicians, Hospitals and other healthcare providers within the PPO network by location and specialty), or may visit the Plan Administrator’s website at http://myimglobal.com to obtain such information.

Renewal of Coverage

Subject to the Terms of the Termination of Master Policy and Termination of Coverage for Insured Persons sections, an Insured Person whose initial Period of Coverage is at least three (3) months can request coverage under this insurance plan to be renewed a minimum of five (5) days until reaching  a maximum of sixty (60) continuous months in accordance with and subject to the Terms of the plan then in effect (including the Terms of the then applicable Master Policy) and so long as renewal Premium is paid when due and the Insured Person otherwise continues to meet the applicable eligibility requirements of the plan.

The Company’s commitment and the Insured Person’s ability to renew is also subject to termination upon thirty (30) days written notice to the other party prior to the expiration date of the then existing Period of Coverage. The Company reserves the right in its sole discretion to make changes, additions and/or deletions to the Terms of the Master Policy, this Certificate, renewals or replacements of either, and/or to the insurance plan (including the issuance of Riders to effectuate same) at any time or from time to time after the Effective Date of Coverage of this Certificate, upon no less than ninety (90) days prior written notice to the Assured and the Insured Person (“Notice of Amendment”). The Notice of Amendment shall include a complete description of the changes, additions and/or deletions to be made, the effective date thereof (the “Change Date”), and notice of the Insured Person’s cancellation rights as set forth below, and shall be sent first class mail, postage pre-paid, to the last known residence or mailing address of the Insured Person. Upon issuance of the Notice of Amendment, the Assured and/or the Insured Person shall have the right to request cancellation of this Certificate above, at any time prior to the Change Date; provided, however that cancellation under this section shall be at the option of the Insured Person, and coverage under this insurance shall terminate with effect from the cancellation date specified by the Insured Person (subject to the provisions of the Termination of Coverage for Insured Persons section. If the Insured Person does not elect to cancel this Certificate in accordance with the foregoing, the changes, additions and/or deletions as made by the Company and specified in said Notice of Amendment shall take effect as of the Change Date specified in the Company’s Notice, and this insurance shall thereafter continue in effect in accordance with its Terms, as so amended and modified.

The Insured Person shall have five (5) days from the Initial Effective Date of Coverage (the “Review Period”) to review the benefits, conditions, limitations, exclusions and all other Terms of the Master Policy as evidenced and outlined by this Certificate. If not completely satisfied, the Insured Person may request cancellation of this insurance retroactive to the Initial Effective Date of Coverage by sending a written request to the Company by email, mail or fax and received by the Company within the Review Period, thereby qualifying to receive a full refund of Premium paid. Upon effectuation of such cancellation and refund, neither the Company nor the Insured Person shall have any further rights, liabilities or obligations under this insurance. After the Review Period, the following conditions apply if the Insured Person wishes to cancel this insurance:

(a) If any claims have been filed with the Company, the Premium is fully earned and is non-refundable.
(b) If no claims have been filed with the Company:

(i) a cancellation fee of fifty dollars ($50.00 USD) will be charged; and
(ii) only Premium covering time periods after cancellation are refundable; and
(iii) only full month Premiums are refundable.

Before Policy Effective Date: Full Refund
After Policy Effective Date (if no claim filed): Unused Portion of Premium (Full Remaining Months Only) - $50 Cancellation Fee

Please send cancellation request at: cancel@imglobal.com and copy that email to us. Our email is given on Contact Us page.

PROOF OF CLAIM

When the Company receives notice of a claim for benefits under this insurance from or on behalf of an Insured Person it will provide the Insured Person with Claimant’s Statement and Authorization Forms (“Claim Forms”) for filing Proof of Claim. The following items must be submitted by or on behalf of the Insured Person to be considered a complete Proof of Claim eligible for consideration of coverage under this insurance (“Proof of Claim”):

  1. a duly completed, timely submitted, and signed Claim Form and authorization for release of information; and
  2. all original itemized bills and statements of services rendered from all Physicians, Hospitals and other healthcare or medical service providers involved with respect to the claim; and
  3. all original receipts for any costs, fees or expenses that have been incurred or paid by or on behalf of the Insured Person with respect to the claim, including without limitation all original receipts for any cash and/or credit card payments.

The Insured Person and/or Physician, Hospital and other healthcare and medical service providers and suppliers shall have ninety (90) days from the date a claim is incurred to submit a complete Proof of Claim, and the Company at its option may pend resolution and adjudication of submitted claims and/or may deny coverage: for Proofs of Claim submitted thereafter; or for incomplete Proofs of Claim; and/or for failure to submit a Proof of Claim; provided, however, that the Company at its option may waive the requirements regarding submission of a new Claim Form for subsequent claims incurred by an Insured Person relating to a continuing Illness, Injury or other medical condition for which a properly completed and signed Claim Form has previously been submitted and received.

APPEALING A CLAIM

In the event the Company denies all or part of a claim, the Insured Person shall have a maximum of two mandatory appeal levels to appeal the denial under which there will be a review of the claim and the determination. Insured Persons shall have sixty (60) days from the date that the notice of denial was mailed to the Insured Person's last known residence or mailing address within which to appeal the determination, and shall have the opportunity to submit written comments, documents, records, and other information relating to the claim. The Company’s review will take into account all comments, documents, records, and other information submitted by the Insured Person relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination. Insured Persons must file two (2) appeals of a claim denial prior to bringing any legal action under the contract of insurance. Upon receipt of a written appeal, the Company shall have an opportunity for further reasonable investigation and/or review as set forth in the Explanation or Verification of Benefits section, and will respond in writing as soon as reasonably practicable, and in any event within ninety (90) days from receipt thereof.