Student Exchange Program Standard Benefits

Schedule of Benefits

All amounts listed are in U.S. dollars. Click the titles to see further information.


PLAN INFORMATION & HIGHLIGHTS - Standard Short-Term Travel Plan
Plan Maximum Choice of $50,000, $250,000 or $500,000 per illness or injury with a Lifetime Maximum of $5,000,000
Coinsurance 100%
Deductible $100 per Illness or Injury
Treatment Period 60 days per chronic illness
MyIMGSM 24 hour secure access from anywhere in the world to manage your account at anytime
International Emergency Care A wide range of international emergency benefits available including emergency evacuation, emergency reunion, and return of mortal remains
Dependent Coverage Coverage not only provided for dependents, but for faculty, scholars, students and exchange participants as well
Optional Add-on Plan More Information
Baggage
Loss/Theft of Baggage $250
Loss/Theft of Valuables $250
Loss/Theft of Personal Papers $250
Legal Assistance
Binder Fee $500 when served with summons
Personal Liability
Injury to Third Party $2,000 limit after $100 deductible
Damage to Third Person Property $500 limit after $100 deductible, secondary to any other insurance
Limited High School Sports Coverage URC*
Sports Rider (apply 1.20 rate factor) Up to Policy Maximum
The Sports Rider adds coverage for jet skiing, scuba diving, snow skiing, snowboarding, snowmobiling, snorkeling, surfing, wakeboarding, water skiing and windsurfing.
MEDICAL BENEFITS USUAL, REASONABLE AND CUSTOMARY CHARGES, SUBJECT TO DEDUCTIBLE AND COINSURANCE
Hospital Room and Board Up to Policy Maximum for average semi-private room rate
Hospital Intensive Care URC*
Physical Therapy URC* - 1 visit per day
Physician Visit URC*
Optional Add-on Plan More Information
Baggage
Loss/Theft of Baggage $250
Loss/Theft of Valuables $250
Loss/Theft of Personal Papers $250
Legal Assistance
Binder Fee $500 when served with summons
Personal Liability
Injury to Third Party $2,000 limit after $100 deductible
Damage to Third Person Property $500 limit after $100 deductible, secondary to any other insurance
Limited High School Sports Coverage URC*
Sports Rider (apply 1.20 rate factor) Up to Policy Maximum
The Sports Rider adds coverage for jet skiing, scuba diving, snow skiing, snowboarding, snowmobiling, snorkeling, surfing, wakeboarding, water skiing and windsurfing.
Student Health Center $5 co-pay per visit
Prescription Drugs Up to Policy Maximum
Eligible Medical Expenses URC*
Emergency Room URC*
Charges incurred for the use of the Emergency Room due to an accident are covered up to the Policy Maximum.
Emergency Illness - with in-patient admission URC*
Emergency Illness - without in-patient admission Additional $250 deductible
Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admittance to the hospital.
Dental
Injury due to an accident: $500

Sudden dental pain: $250
INTERNATIONAL EMERGENCY CARE (WHEN COORDINATED THROUGH THE PLAN ADMINISTRATOR)
Emergency Medical Evacuation $50,000 Lifetime Maximum
Each plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to $50,000.
Emergency Reunion $15,000 Lifetime Maximum
Each plan also provides emergency reunion coverage, up to $5,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.
Return of Mortal Remains $25,000
If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the home country will be covered up to a maximum of $7,500.
Political Evacuation Up to $10,000
If the United States Department of State, Bureau of Consular Affairs issues a travel advisory that becomes effective on or after the Insured Person's date of arrival in the Host Country, the Company will pay up to $10,000 for transportation to the nearest place of safety or for repatriation to the Insured Person's home country or country of residence provided that:
  • 1. The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular affairs issues the travel advisory;
  • 2. Political Evacuation and Repatriation is approved and coordinated by the Company.

To be eligible for the Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in critical medical situations, and approved in advance and coordinated by IMG.
ADDITIONAL BENEFITS
Accidental Death $25,000
Dismemberment $25,000 two limbs;
$12,500 one limb
Terrorism Coverage Up to $50,000 Lifetime Maximum

Each plan 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 6 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.

Sudden Recurrence of a Pre- existing Condition (U.S. citizens)
Medical Up to $5,000 of eligible expenses
Emergency Medical Evacuation Up to $25,000 of eligible costs and expenses
OPTIONAL ADD-ON PLAN
Baggage
Loss/theft of Baggage $250
Loss/theft of Valuables $250
Loss/theft of Personal Papers $250
Legal Assistance
Binder Fee $500 when served with summons
Personal Liability
Injury to third party $2,000 limit after $100 deductible
Damage to third person property $500 limit after $100 deductible. Secondary to any other insurance in force
Limited High School Sports Coverage URC*

Basic Benefits


PLAN INFORMATION & HIGHLIGHTS - Basic Short-Term Travel Plan
Plan Maximum $10,000 per illness or injury with a Lifetime Maximum of $5,000,000.
Coinsurance 100%
Deductible $100 per Illness or Injury
Treatment Period 60 days per chronic illness
MyIMGSM 24 hour secure access from anywhere in the world to manage your account at anytime
International Emergency Care $10,000 per illness or injury with a Lifetime Maximum of $5,000,000.
Dependent Coverage Coverage not only provided for dependents, but for faculty, scholars, students and exchange participants as well
Optional Add-on Plan More Information
Baggage
Loss/Theft of Baggage $250
Loss/Theft of Valuables $250
Loss/Theft of Personal Papers $250
Legal Assistance
Binder Fee $500 when served with summons
Personal Liability
Injury to Third Party $2,000 limit after $100 deductible
Damage to Third Person Property $500 limit after $100 deductible, secondary to any other insurance
Limited High School Sports Coverage URC*
Sports Rider (apply 1.20 rate factor) Up to Policy Maximum
The Sports Rider adds coverage for jet skiing, scuba diving, snow skiing, snowboarding, snowmobiling, snorkeling, surfing, wakeboarding, water skiing and windsurfing.
MEDICAL BENEFITS Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.
Hospital Room and Board Up to semi-private room rate
Hospital Intensive Care URC*
Physical Therapy URC* - 1 visit per day
Physician Visit URC*
Student Health Center $5 co-pay per visit
Prescription Drugs Up to Policy Maximum
Eligible Medical Expenses URC*
Emergency Room URC*
Charges incurred for the use of the Emergency Room due to an accident are covered up to the per injury Plan Maximum.
Emergency Illness - with in-patient admission URC*
Emergency Illness - without in-patient admission Additional $250 deductible
Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admittance to the hospital.
INTERNATIONAL EMERGENCY CARE (WHEN COORDINATED THROUGH THE PLAN ADMINISTRATOR)
Emergency Evacuation $25,000 Lifetime Maximum
Each plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to $25,000.
Emergency Reunion $5,000 Lifetime Maximum
Each plan also provides emergency reunion coverage, up to $5,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.
Return of Mortal Remains $7,500
If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the home country will be covered up to a maximum of $7,500.
Political Evacuation Up to $10,000
If the United States Department of State, Bureau of Consular Affairs issues a travel advisory that becomes effective on or after the Insured Person's date of arrival in the Host Country, the Company will pay up to $10,000 for transportation to the nearest place of safety or for repatriation to the Insured Person's home country or country of residence provided that:
  • 1. The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular affairs issues the travel advisory;
  • 2. Political Evacuation and Repatriation is approved and coordinated by the Company.

To be eligible for the Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in critical medical situations, and approved in advance and coordinated by IMG.
ADDITIONAL BENEFITS
Accidental Death $5,000
Dismemberment $5,000 two limbs;
$2,500 one limb
Terrorism Coverage Up to $50,000 Lifetime Maximum

Each plan 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 6 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.

Sudden Recurrence of a Pre- existing Condition (U.S. citizens)
Medical Up to $5,000 of eligible expenses
Emergency Medical Evacuation Up to $25,000 of eligible costs and expenses
OPTIONAL ADD-ON PLAN
Baggage
Loss/theft of Baggage $250
Loss/theft of Valuables $250
Loss/theft of Personal Papers $250
Legal Assistance
Binder Fee $500 when served with summons
Personal Liability
Injury to third party $2,000 limit after $100 deductible
Damage to third person property $500 limit after $100 deductible. Secondary to any other insurance in force
Limited High School Sports Coverage URC*

* This Web page contains only a consolidated and summary description of all current benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.