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U.S. Students Abroad Health Plan
For American Students Engaged in International Educational Activities
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Each year, over 100,000 students and scholars traveling protect themselves with HTH insurance plans. Our plans combine comprehensive, competitively priced insurance protection with critical information and international medical assistance services to help you find and pay for quality healthcare services all around the world.
HTH Worldwide has carefully selected and contracted with over 5,000 physicians and hospitals in 180 countries outside the U.S. to serve our members.
HTH Worldwide Insurance Services administers these plans, delivering convenient customer service online and via a toll-free multilingual call center. Members can search for a doctor, view plan information, download forms and more.
Leadership
HTH is a leader in global health insurance and assistance, serving hundreds of thousands of globalists annually.
Highest Standards
Every aspect of HTH's insurance programs is designed to meet the highest expectations for quality and service.
Good Value
HTH offers plans tailored to customers' needs and priced to meet most budgets.
U.S. Citizens and Legal Residents of the United States ages 14 to 64, who are students/scholars/faculty members and who are engaged in international educational activities outside of the United States. Online courses are not eligible.
You may enroll Online or complete a Paper application and mail to:
Insubuy, Inc.
4700 Dexter Dr.
Suite 100
Plano TX 75093
or fax to:
(972) 767-4470
Eligible Participants may enroll prior to departure from their home country, within 31 days of arrival in the Country of Assignment or within 31 days of matriculation/registration. The coverage may be purchased to cover any period of time, in full months, up to 12 months.
Coverage will begin on the date requested in the enrollment form or the date the completed enrollment form and fees have been received by HTH Worldwide Insurance Services, whichever is later. Coverage is effective 24 hours a day while the Covered Person is outside the United States. Coverage will commence at 12:01 a.m. on the effective date of the insurance and terminate at 11:59 p.m. on the last date of coverage. Coverage will terminate on the earliest of the following dates: 1) upon termination of the Policy; 2) the date the participant ceases to meet eligibility requirements; 3) upon expiration of period of coverage requested in the enrollment form; 4) on the first date for which premium and fees have not been paid. Facsimile: Coverage begins/ends at 12:01 AM / 11:59 PM EST respectively on the day which is at least 24 hours after the time and date of the receipt of the enrollment form.
HTH Worldwide reserves the right to provide the name and other non-health-related information to the enrollee's sponsoring institution
Coverage shall be continuous if acceptable renewal form and premium are received by HTH Worldwide Insurance Services prior to the expiration of coverage. There is a 31-day grace period in which to pay the premium due. Premiums will be based upon the attained age of the covered participant at the time of renewal. Any Covered Person whose coverage under the Policy lapses after the grace period shall be subject to all Policy exclusions as of any subsequent effective date. Renewals may be subject to a minimum premium payment.
Ten-Day Money-Back Guarantee: YOUR SATISFACTION IS GUARANTEED. If you are not completely satisfied with our product, simply return your Certificate or Policy of Insurance within ten days of receipt and include a letter indicating your desire to cancel. If you have not already used the insurance benefits, you will receive a full refund.
| SCHEDULE OF BENEFITS |
Limits for Eligible Participant |
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MEDICAL EXPENSES
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| Lifetime Maximum Benefits |
$250,000 |
| Policy Year Maximum Benefits |
$100,000 |
| Maximum Benefit per Injury or Sickness |
$100,000 |
| Basic Medical Expense Benefit per Injury or Sickness |
Up to $10,000 Maximum: 100% of Reasonable Expenses After Deductible |
| Supplemental Major Medical Expense Benefit (SMM) per Injury or Sickness |
After Basic Medical Expense Benefit Maximum has been paid, 80% of Reasonable Expenses up to an additional $90,000 Maximum |
| Physician Office Visits |
For Basic, After Deductible, 100% of Reasonable Expenses.
For SMM Benefit, After Deductible, 80% of Reasonable Expenses |
Inpatient Hospital Services
Maximum payment for Intensive Care Facility up to $1,000 per day |
For Basic, After Deductible, 100% of Reasonable Expenses.
For SMM Benefit, After Deductible, 80% of Reasonable Expenses |
| Hospital and Physician Outpatient Services |
For Basic, After Deductible, 100% of Reasonable Expenses.
For SMM Benefit, After Deductible, 80% of Reasonable Expenses |
| Pregnancy Coverage |
Reasonable Expenses up to Maximum per Policy Year |
| Deductible |
$50 per Injury or Sickness |
| Benefit Period |
After the Covered Person's effective date or until coverage terminates under the Policy, whichever is less |
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ACCIDENTAL DEATH AND DISMEMBERMENT
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Maximum Benefit Principal Sum up to $10,000 |
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REPATRIATION OF REMAINS
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Maximum Benefit up to $15,000 |
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MEDICAL EVACUATION
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Maximum Lifetime Benefit for all Evacuations up to $100,000 |
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BEDSIDE VISIT
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Up to a maximum benefit of $1,500 for the cost of one (1) economy
round-trip airfare ticket to, and the hotel accommodations in, the place
of the Hospital Confinement for one (1) person |
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MEDICAL EXPENSES
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Limits - Covered Person
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| Maternity Care for a Covered Pregnancy |
Reasonable Expenses |
| Inpatient treatment of mental and nervous disorders including drug or alcohol abuse |
Reasonable Expenses up to $2,500 Maximum per lifetime |
| Outpatient treatment of mental and nervous disorders including drug or alcohol abuse |
Reasonable Expenses up to $500 Maximum per lifetime |
| Therapeutic termination of pregnancy |
Reasonable Expenses up to $500 Maximum per Policy Year |
| Repairs to sound, natural teeth required due to an Injury |
100% of Reasonable Expenses up to $250 per tooth |
| Outpatient prescription drugs |
50% of actual charge |
| Professional ground ambulance service to nearest hospital |
Reasonable Expenses up to $250 per Injury or Sickness |
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IN ADDITION TO INSURANCE BENEFITS, THIS PLAN PROVIDES GLOBAL HEALTH AND SAFETY SERVICES:
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| Global 24-hour telephone medical assistance |
including the evaluation and monitoring of medical treatment and comprehensive management of evacuations and repatriations. |
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HTH's Global Health and Safety accessed online and via your mobile phone:
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| HTH Physician Community |
available in more than 180 countries. Find a qualified, contracted English-speaking doctor in your destination. |
| CityHealth ProfilesSM |
bring you critical healthcare information, including vaccination requirements and emergency listings, for over 600 destinations outside the U.S. |
| Security Profiles |
give you up-to-date information about terrorism, kidnapping and threats, as well as advice on how to minimize risks in nearly 500 destinations. |
| HTH Drug Translation Guide |
help you find the prescription or over-the-counter equivalent medication you need. |
| HTH Medical Phrase and Terms Translation Guide |
helps you communicate clearly with a doctor, nurse or pharmacist. |
| mPassport® |
U.S. Students Abroad provides convenient access to HTH's Global Health and Safety databases online and via mPassport®. Travelers can search for a doctor or translate medical terms, phrases and medications right from their handheld mobile device. mPassport® includes My Digital ID. Display your health plan identification card on your mobile phone.
Access top notch care via:
The Web
Your Mobile Device
HTH's 24/7 call center |
Rates are subject to change.
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IF PARTICIPANT IS
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PARTICIPANT ONLY
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| Under Age 31 |
$38 |
| Age 31- 64 |
$100 |
Any person who knowingly and with intent to defraud or deceive any insurance company submits an insurance application or statement of claim containing any false, incomplete or misleading information may be subject to civil or criminal penalties, depending upon state law.
For your protection, California requires the following to appear on this form: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.
In Florida, any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim or an insurance application containing any false, incomplete or misleading information is guilty of a felony of the third degree.
In Kentucky, any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. Any application for insurance in writing by the applicant shall be altered solely by the applicant or by his written consent except that insertions may be made by the insurer for administrative purposes only in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant.
In New Jersey, any person who includes any false or misleading information on an application for insurance is subject to criminal and civil penalties.
Applicants applying for accident and health insurance in New York: Any person who knowingly and with intent to defraud or deceive any insurance company submits an insurance application or statement of claim containing any false, incomplete or misleading information may be subject to civil or criminal penalties, depending on state law.
In Ohio, any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
In Oklahoma, WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
In Pennsylvania, any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
All other cancellations will only be allowed only if one of the following requirements are met: 1) proof of ineligibility is provided; or 2) cancellation occurs within the first 10 days from the effective date or most recent renewal date; or 3) the Covered Member requests cancellation in writing. If cancellation is after 10 days, premium will be refunded in whole months only for any unused portion of the enrollment period.
This brochure describes the benefits under the plan of insurance. This is not a contract of insurance. Coverage is governed by an insurance policy issued to Global Citizen Association underwritten by HM Life Insurance Company, Pittsburgh, PA, NAIC # 0812-93440 or HM Life Insurance Company of New York, New York, NY, NAIC # 0812-60213 under policy form HM207-SI, HM207-TH or HM207-EH GC. The coverage requested may not be available in all states. Complete information on the insurance is contained in the Certificate of Insurance, which will be provided to you as evidence of coverage under the policy.
Any provision of this plan as described that may be in conflict with the laws of the state where the purchaser is located will be administered to conform with the requirements of that state's laws, including mandated state benefits. Therefore, Participants may be entitled to additional benefits.
The Insurer does not pay benefits for loss due to a Pre-Existing Condition during the first one (1) year of coverage. Pre-Existing Conditions will be covered after the Covered Person's coverage has been in force for one (1) year. This limitation does not apply to the Medical Evacuation Benefit, the Repatriation of Remains Benefit and to the Bedside Visit Benefit. Unless specifically provided for elsewhere under the Policy, the Policy does not cover loss caused by or resulting from, nor is any premium charged for, any of the following:
- Preventative medicines, routine physical examinations or any other examination where there are no objective indications of impairment in normal health, including routine care of a newborn infant
- Services and supplies not Medically Necessary for the diagnosis or treatment of a Sickness or Injury
- Surgery for the correction of refractive error and services and prescriptions for eye examinations, eyeglasses or contact lenses or hearing aids, except when Medically Necessary for the Treatment of an Injury
- Plastic or cosmetic surgery, unless they result directly from an Injury which necessitated medical treatment within 24 hours of the Accident
- For diagnostic investigation or medical treatment for infertility, fertility or birth control
- Expenses incurred in excess of Reasonable Expenses
- Expenses incurred for Injury resulting from the Covered Person's being legally intoxicated or under the influence of alcohol as defined by the jurisdiction in which the Accident occurs. This exclusion does not apply to the Medical Evacuation Benefit, to the Repatriation of Remains Benefit and to the Bedside Visit Benefit
- Voluntarily using any drug, narcotic or controlled substance, unless as prescribed by a Physician. This exclusion does not apply to the Medical Evacuation Benefit, to the Repatriation of Remains Benefit and to the Bedside Visit Benefit
- Organ or tissue transplant
- Participating in an illegal occupation or committing or attempting to commit a felony
- For treatment, services, supplies or Confinement in a Hospital owned or operated by a national government or its agencies (This does not apply to charges the law requires the Covered Person to pay)
- While traveling against the advice of a Physician, while on a waiting list for a specific treatment or when traveling for the purpose of obtaining medical treatment
- The diagnosis or treatment of Congenital Conditions, except for a newborn child insured under the Policy
- Expenses incurred within the Covered Person's Home Country
- Treatment to the teeth, gums, jaw or structures directly supporting the teeth, including surgical extractions of teeth, TMJ dysfunction or skeletal irregularities of one or both jaws including orthognathia and mandibular retrognathia
- Expenses incurred in connection with weak, strained or flat feet; corns; or calluses
- Diagnosis and treatment of acne and sebaceous cyst
- Outpatient treatment for specified therapies including, but not limited to, Physiotherapy and acupuncture
- Deviated nasal septum, including submucous resection and/or surgical correction, unless treatment is due to or arises from an Injury
- Self-inflicted Injuries while sane or insane; suicide; or any attempt thereat while sane or insane. This exclusion does not apply to the Medical Evacuation Benefit, to the Repatriation of Remains Benefit and to the Bedside Visit Benefit
- Self-inflicted Injuries while sane or insane; suicide; or any attempt thereat while sane or insane. This exclusion does not apply to the Medical Evacuation Benefit, to the Repatriation of Remains Benefit and to the Bedside Visit Benefit
- Loss due to war, declared or undeclared; service in the armed forces of any country or international authority; riot; or civil commotion
- Riding in any aircraft, except as a passenger on a regularly scheduled airline or charter flight
- Elective termination of pregnancy
- Loss arising from participation in professional sports, scuba diving, hang gliding, parachuting or bungee jumping
- Medical Treatment Benefits provision for loss due to or arising from a motor vehicle Accident if the Covered Person operated the vehicle without a proper license in the jurisdiction where the Accident occurred
- Under the Accidental Death and Dismemberment provision, for loss of life or dismemberment for or arising from an Accident in the Covered Person's Home Country
- Expenses incurred for treatment of sports-related accidents resulting from interscholastic, intercollegiate, intramural, club or professional sports
- Expenses incurred as a result of pregnancy that is not covered
*subject to state law
The Administrator is HTH Worldwide
One Radnor Corporate Center
Suite 100
Radnor, PA 19087
HM Life Insurance Company, Pittsburgh, PA, NAIC # 0812-93440 or HM Life Insurance Company of New York, New York, NY, NAIC # 0812-60213 under policy form series HM207-SI, HM207-TH or HM207-EH GC.
The coverage requested may not be available in all states.
03/01/2011
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