Gateway Student Health Advantage (US & Non-US) Highlights
Overview
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 |
Benefits:
|
SCHEDULE OF BENEFITS
(All amounts listed are in U.S. dollars. URC - Usual, Reasonable, Customary)
|
|
PLAN INFORMATION |
| 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
$50 per Illness/Injury if Treatment received in Student Health Center |
| Coinsurance |
|
| Chargers incurred outside the U.S. |
No Coninsurance |
| Chargers incurred outside the U.S. |
|
| 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 & Unexpencted 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 lifeime maximum |
| |
|
| 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. |
| AD&D |
|
| Student |
$25,000 |
| Dependent Spouse |
$10,000 |
| Dependent Child |
$5,000 |
| Disemberment Levels |
Scheduled |
| Benefit Period |
60 days |
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).