INTERNATIONAL

STUDENT HEALTH

INSURANCE

INDIVIDUAL APPLYGROUP APPLY

INTERNATIONAL STUDENT HEALTH INSURANCE

Gateway Student Travel Medical Insurance (US & Non-US)

Most students are required to have student travel medical insurance when they travel to other countries for an extended period of time as part of their education. No one knows in advance when an illness or accident may strike a student: it could happen whether they are at home or abroad. When planning to study abroad, international students need to make sure their plans include the purchase of student travel health insurance to safeguard them in any unfortunate event. Long-term medical coverage should include hospital treatment, physical therapy, prescription drugs and emergency medical evacuation among other important benefits.

COVERAGE OVERVIEW

Gateway Student Health Advantage is an international student health insurance plan, provided to international and study abroad students as well as groups of students or scholars. It is valid for US students who are studying in a foreign country as well as non-US students traveling and studying in the USA. Student Health Advantage insurance meets student visa requirements and the coverage includes benefits for maternity, mental health, organized sports and international emergency care. This comprehensive medical insurance plan can be renewed on an annual basis.

• Long-term medical coverage
• Coverage for individuals and groups and their dependents
• Coverage can be extended up to 12 months from the initial effective date if a minimum of three months is purchased
• Freedom to seek treatment with the hospital or doctor of your choice
• 24 hour secure access from anywhere in the world to manage your account at any time
• Universal Rx pharmacy discount savings
• Meets student visa requirements
• Maternity coverage
• Mental health coverage
• Organized sport coverage
• International emergency care
• Pre-existing conditions coverage after 12 months

PLAN HIGHLIGHTS

As a global student, assurance and peace of mind are a priority when you study abroad. That’s why IMG has developed Student Health Advantage, an international health care plan designed to specifically meet the needs of international students involved in long-term educational programs. The plan offers a complete package of international benefits available 24 hours a day.The following conditions apply to all persons applying for and/or enrolling in Gateway Student Health Advantage:
• The individual or group member must be a full-time student or scholar at a college or university.
• The individual or group member must be residing outside his/her home country for the purpose of pursuing international, educational activities including but not limited to college course work, conducting research or teaching for a temporary period of time.
• Must not have obtained residency status in Host Country.
• Dependents have to be legal dependents, traveling with the individual applicant or group member and traveling outside their home country.
• Family members do not constitute a group.

Obtaining coverage is as simple as:
• Filling out the Enrollment Form with the information requested.
• Mailing or faxing the above information to your independent agent or IMG.

PREMIUM | STUDENT HEALTH ADVANTAGE
An international health care plan designed to specifically meet the needs of international students involved in long-term educational programs.All premium rates are in U.S. dollars and are effective through 1-Oct-2011. Rates include surplus lines tax where applicable. A dependent child is your child shown on the Application Form over 14 days and under 19 years of age, traveling with the individual or the group member as a dependent, and for whom premium has been paid. U.S. Citizens – Monthly Rates

Age Student Spouse Dep. Child
Under 19 $57 $335 $62
19-23 $63 $335 $62
24-30 $83 $367 $62
31-40 $125 $489 $62
41-50 $204 $502 $62
51-64 $271 $489 $62

 

SCHEDULE OF BENEFITS (All amounts listed are in U.S. dollars.)
Lifetime Maximum
Student | $500,000
Dependent | $50,000

Per Illness/Injury Maximum
Student | $300,000
Each eligible dependent  |  $50,000
Deductible  |  $100 per Illness/Injury OR $50 per Illness/Injury if Treatment received in Student Health Center

Coinsurance
Charges incurred outside the U.S.  |  No Coninsurance
In PPO network or Student Health Center  |  No Coninsurance
Out of PPO network  |  80% of the first $5,000 of eligible charges, then 100% therafter.

MEDICAL BENEFITS

*Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.

Hospital Room and Board | Average semi-private room
Intensive Care | URC*
Maternity | URC*
Routine Nursery Care | $750 maximum per period of coverage

EMERGENCY ROOM
Injury | URC*
Illness resulting in hospitalization | URC*
No hospitalization | Subject to additional $250 deductible

MENTAL HEALTH (Includes alcohol and substance abuse. Treatment at Student Health Center is not eligible)
Out-patient | $50 per day, $500 lifetime maximum
In-patient | URC* to $10,000 lifetime maximum
Physical Therapy | URC* – limit once per day

PRESCRIPTION DRUGS
In-patient | URC*
Out-patient | 50% of actual charges

LOCAL AMBULANCE | URC*
Per Injury | Up to $350
Per Illness (only if admitted in-patient) | Up to $350

DENTAL
Injury due to covered Accident | $500
Sudden & Unexpected Pain | $350

All Other Eligible Medical Expenses | URC*

INTERNATIONAL EMERGENCY CARE
Emergency Medical Evacuation | Up to $500,000 lifetime maximum (independent of Maximum Limit)
Emergency Reunion | $50,000 maximum
Return of Mortal Remains | $50,000 maximum
Political Evacuation | Up to $10,000 lifetime maximum

EXCLUSIONS

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under Student Health Advantage.

A pre-existing condition is defined as any Injury, Illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the 12 months prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom

Treatment or surgeries which are elective, investigational, experimental or for research purposes.

War, military action, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.

Immunizations and routine physical exams.

Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.

Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.

Pre-natal, post-natal, and newborn care, unless related to a Covered Pregnancy, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.

Expenses in excess of $5,000 for Injury or Illness sustained while participating in amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding,snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and whitewater rafting.

Vision or ear tests and the provision of visual or hearing aids.

Vocational, recreational, speech or music therapy.

Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.

Charges, Injuries and/or Illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.

Treatment for, and Injuries and/or Illnesses resulting or arising from, substance abuse or drug addiction. Injury and/or Illness resulting or arising from being under the influence of alcohol or drugs; and Injury or Illness resulting from operating any type of vehicle after consuming any alcohol or drugs.

Willful self-inflicted Injury or Illness. Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.

Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured Organ or tissue transplants or related services.

Illness or Injury where the trip to the host country is undertaken for treatment or advice for such illness or Injury, except as expressly provided for in the certificate of insurance.

Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

ADDITIONAL INFORMATION

Intercollegiate/Interscholastic/ Intramural or Club Sports | $5,000 per Injury/Illness Medical Expenses only

Incidental Home Country Coverage | Up to a cumulative two weeks

Pre-existing Conditions | After 12 months of continuous coverage

Terrorism Coverage | Up to $50,000 lifetime maximum
Student Health Advantage provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the six months prior to the insured person’s date of arrival.This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person’s arrival date, and the insured person unreasonably fails or refuses to depart the country or location.

Accidental Death & Dismemberment
Student | $25,000
Dependent Spouse | $10,000
Dependent Child | $5,000
Dismemberment Levels | Scheduled
Benefit Period | 60 days

CONTACT US

If you have any questions regarding IMG or the products located on this website, please contact us. We are available to provide support to our producers and prospective clients. Our contact information is below. Additionally, you may use the online inquiry form. An IMG representative will review your questions or comments, and respond in a timely manner.

International Medical Group
2960 North Meridian Street
Indianapolis, IN USA 46208-4715

Telephone: 1.317.655.4500 or 1.877.808.7434
Fax: 1.317.655.4505
Email: insurance@imglobal.com

For all claims correspondence, please use the following address:
International Medical Group
Claims Department
PO Box 88500
Indianapolis, IN 46208-0500

To submit applications, underwriting information or premium, please use the following address:
International Medical Group
PO Box 88509
Indianapolis, IN 46208-0509

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