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Student Health Advantage

Long-term worldwide medical insurance for international students and scholars

1 Month to 5 Years

Hello. Hola. Hallo. Hej.

You can greet someone in a foreign country in many ways. When you travel, stay safe and secure by saying hello to Student Health AdvantageSM, a one-of-a-kind international medical insurance plan that brings you Global Peace of Mind® when you're traveling abroad.

Secure, Reliable Medical Insurance

As an international student or scholar, the thrill of studying outside of your home country is extraordinary. Your new surroundings are amazing and you're involved in new and exciting experiences. You're seeing and visiting places for the first time, while receiving the benefits of a long-term education.

Caught up in all of the excitement, you may not think about falling ill or becoming injured during your studies. Without warning, your experience abroad can quickly become frightening and risky if you're not prepared for a medical emergency. As an international student, peace of mind is a priority when you study abroad.

Your educational adventure or cultural exchange program should be enjoyable and gratifying. Maintaining the ability to be flexible and responsive, Student Health AdvantageSM has been developed, an international medical plan designed to specifically meet the needs of international students, scholars, and people involved in long-term educational and cultural exchange programs. The plan offers a complete package of benefits while outside your home country available 24 hours a day, providing you with Global Peace of Mind®. After all, you are global. Your medical insurance should be too.

Student Health AdvantageSM

  • Designed to meet U.S. student, scholar and cultural exchange program visa requirements
  • Coverage for individuals or groups of five or more participants and their dependents
  • Mental & Nervous Disorders and Substance Abuse coverage
  • Intercollegiate/Interscholastic/Intramural or Club Sports coverage
  • Maternity coverage (Platinum only)
  • International emergency care

How Does the Affordable Care Act (ACA) Affect My Coverage?

Non-US Citizens: As non-resident aliens, international students, scholars, and people involved in cultural exchange programs on F, J, M and Q visas (and certain family members) are not subject to the individual mandate for their first five years in the U.S. All other J categories (teacher, trainee, work and travel, au pair, high school, etc.) are not subject to the individual mandate for two years (out of the past six). Since international students are not subject to the mandate, they are not required to purchase a plan that meets PPACA requirements and can purchase Student Health Advantage.

US Citizens: Under ACA, all U.S. citizens, nationals and resident aliens are required to purchase minimum essential coverage (ACA compliant coverage), unless they are exempt. Exempt U.S. citizens include U.S. citizens who reside outside of the U.S. for 330 of any 365-day period, or have a tax home (main place of work or employment, or if you don't have a main place of work or employment, your main residence) in a foreign country, and is a bona fide resident of a foreign country.

Please note that this insurance is not subject to, and does not provide benefits required by, ACA. On January 1, 2014, ACA requires U.S. citizens, U.S. nationals and resident-aliens to obtain ACA compliant insurance coverage unless they are exempt from ACA (international. students on F, J, M and Q visas (and certain family members of students) are not subject to the individual mandate for their first 5 years in the U.S. All other J categories - teacher, trainee, work and travel, au pair, high school, etc. - are not subject to the individual mandate for 2 years out of the past six). Penalties may be imposed on persons who are required to maintain ACA compliant coverage but do not do so. Eligibility to purchase or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including ACA. Please note that it is solely your responsibility to determine if ACA is applicable to you and the Company and the administrator shall have no liability whatsoever, including for any penalties that you may incur, for your failure to obtain required ACA compliant coverage. For information on whether ACA applies to you or whether you are eligible to purchase the Student Health Advantage, please contact your attorney or CPA.

Custom Products and Services

We know that the reasons for traveling abroad are many and varied - that's why our products are too. Our full-service approach to providing international medical insurance products includes servicing vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence.

But providing insurance coverage is not enough. It's the service and support that matters the most. We've served millions of people around the globe with customer service that's second to none. We provide on-site medical staff who are available 24 hours a day for emergencies, multilingual customer service professionals and dedicated claims administrators who process tens of thousands of claims each year from all over the world. We're with you, providing you Global Peace of Mind®.

SHA Summary of Benefits - Standard Plan

Maximum Limit Student- $500,000 period of coverage
Dependent- $100,000 period of coverage
Per Illness/Injury MaximumStudent- $300,000
Dependent- $100,000
Deductible $100 per Illness/Injury
Student Health Center: $5 copay per visit
Coinsurance Outside the US & Canada: No coinsurance
In PPO Network or Student Health Center within U.S. or Canada: No coinsurance
Out of PPO Network if within U.S. or Canada:
80% of eligible expenses up to $5,000; then 100% thereafter
Hospital Room and Board Average semi-private room rate, including nursing service
Intensive Care URC
Emergency Room Injury URC
Emergency Room Illness resulting in hospitalization URC
Emergency Room Illness without In-
patient Admission
URC; Subject to additional $250 deductible
Mental & Nervous Disorders and Substance AbuseOut-patient- $50 per day; $500 lifetime maximum
In-patient- URC to $10,000 lifetime maximum
Student Health Center Treatment - $0
Prescription DrugsIn-patient URC
Out-patient- 50% of actual charges
Physical TherapyURC- limit 1 visit per day
Local AmbulancePer Injury- up to $350
$350 per illness only if admitted as In-patient
DentalInjury due to covered accident- $500 maximum per accident
Sudden & Unexpected Pain to natural teeth- $350 maximum
Eligible Medical ExpensesURC
Emergency Medical Evacuation$500,000 lifetime maximum
Emergency Reunion$50,000 lifetime maximum
Return of Mortal Remains$50,000 maximum
Political Evacuation and Repatriation$10,000 lifetime maximum
Intercollegiate / Interscholastic/
Intramural or Club Sports
$5,000 maximum per Injury/Illness
Incidental Trip CoverageUp to a cumulative 14 days
Pre-existing ConditionsCharges excluded until after 12 months of continuous coverage
Terrorism$50,000 lifetime maximum
AD&DStudent- $25,000 principal sum
Spouse- $10,000 principal sum
Dependent Child- $5,000 principal sum
Accident Dismemberment percentage of principal sum
Treatment Period60 day minimum

SHA Summary of Benefits - Platinum Plan

Maximum LimitStudent - $1,000,000 per period of coverage
Dependent - $100,000 per period of coverage
Per Illness/Injury MaximumStudent- $500,000
Dependent- $100,000
DeductibleFor treatment received outside the US & Canada: $25 per illness or injury

For treatment received inside the U.S./Canada:
PPO Provider: $25 per illness or injury
Non-PPO Provider: $50 per illness or injury
Student Health Center: $5 copay per visit
CoinsuranceOutside the US & Canada: No coinsurance
In PPO Network or Student Health Center within U.S. or Canada: No coinsurance
Out of PPO Network if within U.S. or Canada:
80% of eligible expenses up to $5,000; then 100% thereafter
Hospital Room & BoardAverage semi-private room, including nursing service
Intensive CareURC
MaternityCoinsurance:
Outside the U.S.: 100% of eligible expenses
In the U.S. PPO Network: 80% of eligible expenses
In the U.S. Out of PPO Network: 60% of eligible expenses
Routine Newborn Care$750 maximum per period of coverage
Emergency Room InjuryURC
Emergency Room Illness resulting in hospitalizationURC
Emergency Room Illness without In-patient AdmissionURC; Subject to additional $250 deductible
Mental & Nervous Disorders and Substance AbuseOut-patient- $50 per day; $500 lifetime maximum
In-patient- URC to $10,000 lifetime maximum
Student Health Center Treatment - $0
Prescription DrugsIn-patient URC
Out-patient- 50% of actual charges
Physical TherapyURC- limit 1 visit per day
Local AmbulancePer Injury- up to $750
$750 per illness only if admitted In-patient
Dental Injury due to covered Accident - $500 maximum per Accident
Sudden & Unexpected Pain to natural teeth- $350 maximum
Eligible Medical ExpensesURC
Emergency Medical Evacuation$500,000 lifetime maximum
Emergency Reunion$50,000 lifetime maximum
Return of Mortal Remains$50,000 maximum
Political Evacuation and Repatriation$10,000 lifetime maximum
Intercollegiate / Interscholastic/
Intramural or Club Sports
$5,000 maximum per injury/illness
Incidental Trip CoverageUp to a cumulative 14 days
Pre-existing ConditionsCharges excluded until after 6 months of continuous coverage
Terrorism$50,000 lifetime maximum
AD&DStudent- $25,000 principal sum
Spouse- $10,000 principal sum
Dependent Child- $5,000 principal sum
Accident Dismemberment percentage of principal sum
Treatment Period 60 day minimum

SHA Premium Rates

SHA Standard rates 2016

Individual Monthly Rates
U.S. Citizens
AgeStudentSpouseDep Child
31 days to 18$52$301$62
19-23$58$301$62
24-30$76$330$62
31-40$115$439$62
41-50$187$451$62
51-64$249$439$62
Non U.S. Citizens
Age Student Spouse Dep Child
31 days to 18$66$346$82
19-23$87$346$82
24-30$101$383$82
31-40$181$510$82
41-50$295$527$82
51-64$394$510$82
Group Monthly Rates
U.S. Citizens
Age Student Spouse Dep Child
31 days to 18$45$257$54
19-23$49$257$54
24-30$65$280$54
31-40$98$374$54
41-50$159$385$54
51-64$212$374$54
Non U.S. Citizens
Age Student Spouse Dep Child
31 days to 18$56$296$69
19-23$74$296$69
24-30$86$327$69
31-40$154$434$69
41-50$252$448$69
51-64$335$434$69

SHA Platinum rates 2016

Individual Monthly Rates
U.S. Citizens
Age Student Spouse Dep Child
31 days to 18$88$516$95
19-23$97$516$95
24-30$128$565$95
31-40$193$753$95
41-50$314$773$95
51-64$417$753$95
Non U.S. Citizens
Age Student Spouse Dep Child
31 days to 18$111$594$126
19-23$146$594$126
24-30$169$656$126
31-40$303$873$126
41-50$496$902$126
51-64$662$873$126
Group Monthly Rates
U.S. Citizens
Age Student Spouse Dep Child
31 days to 18$72$423$78
19-23$80$423$78
24-30$105$463$78
31-40$158$618$78
41-50$258$634$78
51-64$342$618$78
Non U.S. Citizens
Age Student Spouse Dep Child
31 days to 18$91$487$104
19-23$120$487$104
24-30$139$538$104
31-40$249$716$104
41-50$407$740$104
51-64$543$716$104

New premium rates per Insured Person effective June 1, 2016 for eligible individuals whose applications are approved by the administrator. The administrator reserves the right to assess the most current rates at the time of the effective date in the event these rates expire, are modified, or are replaced. Rates include premium tax where applicable.

SHA Optional Riders

Adventure Sports Rider

The Adventure Sports Rider is available for eligible participants. Certain activities designated as adventure sports can be covered up to the maximums listed below. Certain activities are never covered regardless of whether or not the Adventure Sports Rider is issued. For a list of activities which can be considered to be adventure sports, a sample rider can be provided upon request. (Available to insureds through age 64)

AgeLifetime Maximum
31 days - 49$50,000
50-59$30,000
60-64$15,000

SHA Plan Information

Conditions of Coverage

1) Coverage and benefits are subject to the deductible limits, and coinsurance, and all terms of the Certificate of Insurance and Master Policy. 2) Coverage under a Student Health Advantage plan is secondary to any other coverage. 3) Coverage and benefits are for eligible medical expenses which are medically necessary and usual, reasonable and customary. 4) Charges must be administered or ordered by a licensed physician. 5) Charges must be incurred during the Period of Coverage. 6) Claims must be presented to the administrator for payment within ninety (90) days from the date the claim was incurred.

Eligibility

To be eligible to apply to the Student Health Advantage plan, you must:

  • Be a full-time student or scholar, the spouse of the full-time student or scholar, or a dependent traveling with the fulltime student or scholar
  • Reside outside the home country for the purpose of pursuing international educational activities including college course work, research, or teaching for a temporary period of time.
  • Be physically and legally residing in host country with the intent to reside there for at least 30 days on the effective date and at renewal
  • Not be hospitalized, disabled, or HIV+ on the initial effective date.

Renewal of Coverage

Eligible insureds whose initial coverage is at least 3 months can request coverage under the plan be renewed monthly for up to 12 month periods, for a maximum of 60 continuous months, as long as the premium is paid when due and the insured continues to meet the eligibility requirements of the plan.

Enrollment Process

Before you begin your travel, simply online or fill out the application and calculate the estimated premium for the time period you, your group, and/or your dependents will be traveling. Once you have completed the Application, return it to us.

You can apply over the phone as well as by calling us.

Eligible individuals listed on the Application and for whom premiums have been paid will be covered from the latest of the following dates:

  1. The date the administrator approves your completed Application and receives the appropriate premium
  2. The date you depart from your home country
  3. The date requested on your Application

Fulfillment Kits

We process applications in a quick, timely manner. Once processing is complete, we will mail and/or email the fulfillment kit(s) to the address/email listed in the Application. The fulfillment kit(s) will include an Identification Card(s), and the insurance certificate providing a complete description of the rights and benefits under the contract. For your convenience, you will get emailed this information and may also access it from Client Center.

If you do not choose Online Fulfillment, we will mail your fulfillment materials. This may cause delays. We recommend online fulfillment for immediate access to your coverage information.

SHA Claims Procedure

Precertification

Certain treatment and supplies including hospital admission, inpatient 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 communicate with a representative at the number listed on the Identification Card prior to admittance to a hospital, before receiving certain treatments and supplies, or performance of a surgery. In case of an Emergency Admission, the Precertification 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 eligible for reimbursement must be medically necessary and will be paid or reimbursed at usual, reasonable, customary rates. Please refer to the Certificate Wording for full details of the Precertification requirements.

For Precertification, emergency evacuation and repatriation, please call: In the U.S.: 1.800.628.4664 (toll free) Outside the U.S.: +44(0) 1444-46-5577 (collect if necessary). This information will also be provided on your ID card.

Note: You may begin the Precertification process through the Client Center. Simply look for the Precertification option. You will be asked to provide the required information, which can then be submitted electronically. Once we have received all required information and medical records, our utilization management and review team will review the information provided and normally responds to the insured person or the provider within 2 business days. Please note that this online service will only initiate the process for treatment and supplies outlined in the contract, and it should not be used to request Precertification for emergency admissions, procedures, or evacuations.

Claims Payment

All benefits payable under Student Health Advantage are subject to the terms and conditions in the Certificate of Insurance. To make claim processing efficient, claims for eligible medical expenses may be paid in two ways:

  1. Eligible expenses that have been paid by or on behalf of the insured person may reimbursed by check directly to the insured person.
  2. Eligible expenses that have not yet been paid by the insured person may, at the option of the administrator, be paid either to the insured person or directly to the provider.

Claim forms can be accessed in the Client Center and mailed to the address on the claim form. All contact numbers, claim forms and Certificate of Insurance are included in the fulfillment kit. May also be contacted by fax at 1.317.655.4505.

SHA Services

An online service that allows you to manage your accounts, 24 hours a day, seven days a week, from anywhere in the world. Some features include:

  • Submission and management of claims
  • Initiate Precertification
  • Access Customer Care via email or telephone
  • Locate and recommend a provider/ facility
  • Obtain ID cards and other insurance documents

Locating a Provider

With the Student Health Advantage Plan you may seek treatment while outside your home country with the hospital or doctor of your choice. When seeking treatment in the U.S., you have access to Preferred Provider Organizations (PPO), which are separately organized networks of hundreds of thousands of established, highly qualified health care physicians and many well recognized hospitals in the U.S. You can quickly search the network. Additionally, to help you locate health care providers outside the U.S., we provide an online International Provider AccessSM (IPA), a database of over 17,000 providers.

Our goal is to provide quality medical coverage wherever you may be while outside your home country. The PPO and our IPA enable us to do just that, and our online directories put the information at your fingertips - anytime, anywhere.

Universal Rx Pharmacy Discount Savings

This discount savings program allows you to purchase prescriptions at one of over 35,000 participating pharmacies in the U.S. and receive the lower of 1) Universal Rx contract price or 2) the pharmacy regular retail price. This program is not insurance coverage; it is purely a discount program.

Akeso Care Management®(AkesoCare)

The ability to access quality health care is of paramount importance when a medical emergency arises abroad. To coordinate care and provide U.S. and internationally based medical management services, IMG formed AkesoCare, an on-site specialized division devoted entirely to medical management.

The clinical staff consists of qualified physicians and registered nurses who are experts at assessing the need for medical services and ensuring those services are delivered in a timely, cost-effective manner. AkesoCare has international medical experience, providing services in more than 170 countries worldwide.

AkesoCare is accredited by URAC, an independent, nonprofit organization that is internationally recognized for promoting continuous improvement in the quality and efficiency of health care management. Through a rigorous and comprehensive review that ensures ongoing compliance, AkesoCare earned its URAC accreditation in Health Utilization Management.

From routine medical care to complex case management, from check-ups to emergency medical evacuations, AkesoCare is there for you. They are committed to patient protection and empowerment, quality operations and provider compliance. This translates into better care for you - around the world, around the clock.

Administrator

IMGTM
P.O. Box 88509
2960 North Meridian Street
Indianapolis, IN 46208-0509 USA

Underwriter

Coverage is underwritten and issued by Sirius International Insurance Corporation, rated A (excellent) by A.M. Best and A- by Standard & Poor's (at the time of printing).

FOR ADDITIONAL INFORMATION

Insubuy®, Inc.
4200 Mapleshade Ln, Suite 200
Plano, TX 75093

Toll Free: (866) INSUBUY
Phone: (972) 985-4400
Fax: (972) 767-4470
Website: www.insubuy.com

This invitation to inquire allows eligible applicants an opportunity to seek information about the insurance offered and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract. The contract does contain a pre-existing condition exclusion and does not cover losses or expenses related to a pre-existing condition.

This brochure contains many of the valuable trademarks, names, titles, logos, images, designs, copyrights and other proprietary materials owned and registered and used by of International Medical Group, Inc. and its representatives throughout the world. © 2007-2016 International Medical Group, Inc. All rights reserved.

Version: 1216

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